Department of Nephrology and Hypertension, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Department of Emergency Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
PLoS One. 2018 Jul 26;13(7):e0200708. doi: 10.1371/journal.pone.0200708. eCollection 2018.
Accelerated bone loss occurs rapidly following renal transplantation due to intensive immunosuppression and persistent hyperparathyroidism. In renal transplant recipients (RTRs) due to the hyperparathyroidism the non-dominant forearm is often utilized as a peripheral measurement site for dual-energy x-ray absorptiometry (DXA) measurements. The forearm is also the site of previous created distal arteriovenous fistulas (AVF). Although AVF remain patent long after successful transplantation, there are no data available concerning their impact on radial bone DXA measurements.
In this cross-sectional study we performed DXA in 40 RTRs with preexisting distal AVF (RTRs-AVF) to assess areal bone mineral density (aBMD) differences between both forearms (three areas) and compared our findings to patients with chronic kidney disease (CKD, n = 40), pre-emptive RTRs (RTRs-pre, n = 15) and healthy volunteers (n = 20). In addition, we assessed relevant demographic, biochemical and clinical aspects.
We found a marked radial asymmetry between the forearms in RTRs with preexisting AVF. The radial aBMD at the distal AVF forearm was lower compared to the contralateral forearm, resulting in significant differences for all three areas analyzed: the Rad-1/3: median (interquartile range) in g/cm2, Rad-1/3: 0.760 (0.641-0.804) vs. 0.742 (0.642, 0.794), p = 0.016; ultradistal radius, Rad-UD: 0.433 (0.392-0.507) vs. 0.420 (0.356, 0.475), p = 0.004; and total radius, Rad-total: 0.603 (0.518, 0.655) vs. 0.599 (0.504, 0.642), p = 0.001). No such asymmetries were observed in any other groups. Lower aBMD in AVF forearm subregions resulted in misclassification of osteoporosis.
In renal transplant recipients, a previously created distal fistula may exert a negative impact on the radial bone leading to significant site-to-site aBMD differences, which can result in diagnostic misclassifications.
由于强化免疫抑制和持续性甲状旁腺功能亢进，肾移植后会迅速发生骨丢失加速。在甲状旁腺功能亢进的肾移植受者（RTR）中，非优势前臂通常被用作双能 X 射线吸收法（DXA）测量的外周测量部位。前臂也是先前创建的远端动静脉瘘（AVF）的部位。尽管 AVF 在成功移植后很长时间内仍然保持通畅，但尚无关于它们对桡骨 DXA 测量影响的数据。
在这项横断面研究中，我们对 40 例有先前存在的远端 AVF 的 RTR（RTR-AVF）进行了 DXA 检查，以评估两个前臂（三个区域）之间的面积骨矿物质密度（aBMD）差异，并将我们的发现与慢性肾脏病（CKD，n=40）、预防性 RTR（RTR-pre，n=15）和健康志愿者（n=20）进行比较。此外，我们还评估了相关的人口统计学、生化和临床方面。
我们发现 RTR 中先前存在 AVF 的前臂存在明显的桡骨不对称性。与对侧前臂相比，远端 AVF 前臂的桡骨 aBMD 较低，导致所有三个分析区域均存在显著差异：桡骨 1/3 处的中位数（四分位距），g/cm2，桡骨 1/3：0.760（0.641-0.804）与 0.742（0.642，0.794），p=0.016；超远端桡骨，桡骨 UD：0.433（0.392-0.507）与 0.420（0.356，0.475），p=0.004；和总桡骨，桡骨总：0.603（0.518，0.655）与 0.599（0.504，0.642），p=0.001）。在任何其他组中均未观察到这种不对称性。在 AVF 前臂亚区中较低的 aBMD 导致骨质疏松症的误诊。
在肾移植受者中，先前创建的远端瘘可能对桡骨产生负面影响，导致明显的部位间 aBMD 差异，从而导致诊断错误分类。
