Kidney Disease Center, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.
Int Urol Nephrol. 2023 Dec;55(12):3217-3224. doi: 10.1007/s11255-023-03606-0. Epub 2023 Apr 24.
Pretransplant osteoporosis and vascular calcification probably increase the risk of fractures and cardiovascular events after kidney transplantation. In the present study, we investigated the related risk factors of osteoporosis and vascular calcification among end-stage renal disease (ESRD) patients awaiting kidney transplantation.
A total of 221 ESRD patients (age, 43.4 ± 14.3 years; 125 males and 96 females; median dialysis duration, 61.0 m) awaiting kidney transplantation were enrolled in this cross-sectional study. Serum levels of bone turnover markers and intact parathyroid hormone (iPTH) were analyzed from fasting morning blood samples. Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD). Vascular calcification was evaluated by lateral abdominal radiography and plain radiographic films of the pelvis and hands.
The osteoporosis prevalence was 27.6% in this cohort of kidney transplantation candidates, and the prevalence of vascular calcification was 51.1%. The related factors for osteoporosis and vascular calcification were similar and included older age, longer dialysis duration, parathyroid hyperplasia, and higher levels of iPTH and bone turnover markers. In the multivariable regression model, age and iPTH were independent risk predictors of both vascular calcification and osteoporosis. There were strong, positive correlations between iPTH and all bone turnover markers. The moderate and severe hyperparathyroidism (iPTH 600-1499 pg/ml and iPTH 1500 pg/ml) were related to reduced serum albumin and hemoglobin levels.
The involvement of high iPTH levels in vascular calcification, osteoporosis, and malnutrition indicated the need of treating hyperparathyroidism early in patients awaiting kidney transplantation. Prospective studies are needed to further examine the utility of bone turnover markers.
移植前骨质疏松症和血管钙化可能会增加肾移植后骨折和心血管事件的风险。在本研究中，我们调查了等待肾移植的终末期肾病（ESRD）患者中骨质疏松症和血管钙化的相关危险因素。
本横断面研究纳入了 221 名等待肾移植的 ESRD 患者（年龄 43.4±14.3 岁；男性 125 名，女性 96 名；中位透析时间 61.0 个月）。从空腹清晨血样中分析骨转换标志物和全段甲状旁腺激素（iPTH）的血清水平。双能 X 射线吸收法用于测量骨密度（BMD）。通过侧腹部放射摄影和骨盆及手部的普通放射摄影片评估血管钙化。
该队列中，骨质疏松症的患病率为 27.6%，血管钙化的患病率为 51.1%。骨质疏松症和血管钙化的相关因素相似，包括年龄较大、透析时间较长、甲状旁腺增生以及 iPTH 和骨转换标志物水平较高。在多变量回归模型中，年龄和 iPTH 是血管钙化和骨质疏松症的独立危险因素。iPTH 与所有骨转换标志物之间存在强烈的正相关。中重度甲状旁腺功能亢进症（iPTH 600-1499 pg/ml 和 iPTH 1500 pg/ml）与血清白蛋白和血红蛋白水平降低有关。
高 iPTH 水平与血管钙化、骨质疏松症和营养不良有关，这表明需要在等待肾移植的患者中早期治疗甲状旁腺功能亢进症。需要前瞻性研究进一步检查骨转换标志物的效用。
