Hori Shunta, Tomizawa Mitsuru, Inoue Kuniaki, Yoneda Tatsuo, Onishi Kenta, Morizawa Yosuke, Gotoh Daisuke, Nakai Yasushi, Miyake Makito, Torimoto Kazumasa, Tanaka Nobumichi, Fujimoto Kiyohide
Department of Urology, Nara Medical University, Nara, Japan.
Department of Prostate Brachytherapy, Nara Medical University, Nara, Japan.
In Vivo. 2025 May-Jun;39(3):1492-1504. doi: 10.21873/invivo.13949.
BACKGROUND/AIM: The clinical importance of fracture prevention in patients with end-stage renal disease is well-established. We investigated the roles of bone metabolism-related serum biomarkers and nutritional markers for fractures in Japanese living-donor kidney transplant recipients.
We included 204 consecutive patients who underwent kidney transplantation at Nara Medical University between 2003 and 2022 and retrospectively reviewed their medical charts. The cumulative incidence of fractures was investigated by focusing on bone metabolism-related serum biomarkers and nutritional markers, and related markers were explored.
The age at surgery in the fracture group was significantly higher than that in the no-fracture group (=0.018). Patients with fractures had a significantly higher risk of mortality than those without fractures (=0.0018); cardiovascular mortality was higher in the fracture group than in the non-fracture group (=0.052). The cumulative incidence of fractures (median follow-up period, 98 months) was 4.6% at 1 year, 8.6% at 2 years, 12.3% at 3 years, and 15.5% at 5 years after transplant. Particularly, patients with a survival index <26.1 had a significantly higher risk of fracture (=0.014). Serum intact parathyroid hormone level (a bone metabolism-related biomarker) and survival index (a nutritional marker) were independently related to fractures (=0.046 and =0.022, respectively).
Serum intact parathyroid hormone level and the survival index may play important roles in determining the incidence of fractures in living donor kidney transplant recipients. Identifying patients at high risk of fractures and providing optimal intervention and education may contribute to improved and personalized management strategies.
背景/目的：终末期肾病患者预防骨折的临床重要性已得到充分证实。我们研究了骨代谢相关血清生物标志物和营养标志物在日本活体肾移植受者骨折发生中的作用。
我们纳入了2003年至2022年期间在奈良医科大学接受肾移植的204例连续患者，并对他们的病历进行了回顾性分析。通过关注骨代谢相关血清生物标志物和营养标志物来研究骨折的累积发生率，并探索相关标志物。
骨折组的手术年龄显著高于无骨折组（=0.018）。骨折患者的死亡风险显著高于无骨折患者（=0.0018）；骨折组的心血管死亡率高于非骨折组（=0.052）。移植后1年骨折的累积发生率（中位随访期98个月）为4.6%，2年为8.6%，3年为12.3%，5年为15.5%。特别是，生存指数<26.1的患者骨折风险显著更高（=0.014）。血清完整甲状旁腺激素水平（一种骨代谢相关生物标志物）和生存指数（一种营养标志物）与骨折独立相关（分别为=0.046和=0.022）。
血清完整甲状旁腺激素水平和生存指数可能在决定活体肾移植受者骨折发生率方面发挥重要作用。识别骨折高危患者并提供最佳干预和教育可能有助于改进和个性化管理策略。
