Dr Henry Guo1, Dr Joy Hong1, A/Prof Frances Milat2,3, Dr Matthew Damasiewicz1,2
1Department of Nephrology, Monash Health, Clayton, Australia, 2Department of Medicine, Monash University, Clayton, Australia, 3Department of Endocrinology, Monash Health, Clayton, Australia
Background: Chronic kidney disease mineral and bone disorder (CKD-MBD) can persist post-transplantation and is associated with increased fracture risk. CKD-MBD and fracture screening post-transplantation is variable and specific management remains uncertain.
Aim: To assess the prevalence of CKD-MBD post-transplantation and evaluate our practice pertaining to fracture risk stratification and treatment.
Methods: We conducted a retrospective study of patients (n=88) who underwent kidney transplantation at Monash Health in 2018 with a 24-month follow-up. Demographic, biochemical and dual-energy X-ray absorptiometry (DXA) results were obtained from electronic medical records.
Results: Baseline eGFR was 7 mL/min (SE ± 0.34), increasing to 52 mL/min (SE ± 2.00) and 55 mL/min (SE ± 2.23) at 12 and 24 months respectively. Baseline mean parathyroid hormone (PTH) level was 45.2 pmol/L (SE ± 3.26), improving to 14.4 pmol/L (SE ± 1.60) and 14.2 pmol/L (SE ± 1.49) at 12 and 24 months. Mean alkaline phosphatase (ALP) improved from 116 IU/L (SE ± 6.41) to 112 IU/L (SE ± 4.58) and 95 IU/L (SE ± 3.77) at 12 and 24 months respectively.
At 24 months, 34 patients (38%) had persistent secondary hyperparathyroidism (SHPT) post-transplantation. 52 patients (59%) received a DXA and of those, 40 patients (77%) had osteoporosis at the femoral neck. However only 7 patients (13%) received anti-fracture therapy. Management of SHPT was variable: 17 patients received cholecalciferol, whilst 2 patients received cinacalcet and 3 patients received calcitriol.
Conclusions: SHPT persists in a significant proportion of patients. 59% of patients had a fracture risk assessment and of those 77% had osteoporosis. Specific anti-fracture therapies were only utilised in 13% of patients. Better protocols for fracture risk stratification and management are needed.
Biography:
Henry is a current second-year registrar at Monash Health. He is interested in general nephrology, including dialysis, vascular access, CKD-MBD and Renal Supportive Care.