Kidney Week

Abstract: FR-PO249

Mineral Bone Disorders after Preemptive Kidney Transplantation

Session Information

• Mineral Bone Disease: Transplant and Kidney Stones
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Tinajero Sánchez, Denisse Nayely, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Denisse Nayely Tinajero Sánchez, MD

• Castro Almanza, Carlos Antonio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Carlos Antonio Castro Almanza, MD

• Berman, Nathan, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Nathan Berman, MD

• Canaviri, Vianca Anabel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Vianca Anabel Canaviri, APN

• Cojuc, Gabriel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Gabriel Cojuc, MD

• Marino-Vazquez, Lluvia A., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Lluvia A. Marino-Vazquez, MD

• Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Luis E. Morales-Buenrostro, MD, PhD

• Ramirez-Sandoval, Juan Carlos, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Juan Carlos Ramirez-Sandoval, MD, PhD

Background

Mineral bone disorders are common after kidney transplantation. Preemptive kidney transplantation (PKT) may reduce these risks. We aimed to assess the long-term effects of PKT on mineral metabolism outcomes

Methods

Retrospective cohort study with a median follow-up time of 4 years (range 1-9). We compared kidney transplant recipients (KTRs) who underwent PKT (n=26) with KTRs who received hemodialysis before transplantation (n=359). The outcomes included iPTH, free calcium, phosphate, and eGFR trajectories, as well as the presence of post-transplant persistent hyperparathyroidism (iPTH > upper reference level), persistent hypercalcemia (free Ca >5.2 mg/dL) and graft dysfunction (<30 mL/min/1.73m2). Asymptomatic mild hypercalcemia was monitored unless complications developed

Results

Pre-transplant iPTH levels were similar between the PKT and non-PKT groups (median 479 [238-828] Vs 392 [145-603]; p=0.064). There were no differences in the trajectory of biochemical parameters between groups after transplantation. Similarly, when comparing PKT and non-PKT KTRs, we observed no differences in persistent hyperparathyroidism (39% Vs. 45%, P=0.54), persistent hypercalcemia (73% Vs. 62%, p=0.17), and graft dysfunction (4% Vs. 6%, p=0.58). In both groups, PTH levels below 300 were a protective factor against the development of post-transplant hyperparathyroidism or hypercalcemia

Conclusion

PKT in KTRs without controlled hyperparathyroidism did not decrease the risk of hyperparathyroidism or persistent hypercalcemia after transplantation. Medical treatment of mineral bone disorders, with a target iPTH below 300, likely decreases the risk of adverse outcomes in KTRs, including individuals undergoing PKT