Recent changes in chronic kidney disease-mineral and bone disorders (CKD-MBD) and associated fractures after kidney transplantation.

Background: The management of chronic kidney disease-mineral and bone disorders (CKD-MBD) has recently changed. We investigated the modifications of CKD-MBD with a special focus on the incidence of fractures in the first year after kidney transplantation (KT). Methods: We retrospectively compared 2 groups of patients who consecutively underwent transplantation at our center 5 years from each other. Group 1 consisted of patients (n=152) transplanted between 2004 and 2006, whereas patients in group 2 (n=137) underwent KT between 2009 and 2011. Results: During the end-stage renal disease phase at the time of transplant, cinacalcet and native vitamin D were used significantly more frequently in group 2. Median intact parathyroid hormone (PTH) levels were lower and severe hyperparathyroidism decreased significantly. Vitamin D deficiency dropped from 64% to 20%. After transplantation, persistent hyperparathyroidism (PTH>130 ng/L) and bone turnover markers were significantly reduced in group 2. Native vitamin D supplementation increased over time, whereas the use of active vitamin D was unchanged. The 25OHD and 1,25 OH2D levels were significantly higher. The fracture incidence at 1 year decreased significantly (3.1% vs. 9.1%, p=0.047). No steroid sparing was observed in group 2. Bisphosphonates after KT were more frequently used in group 2. Conclusions: Recent changes in clinical practice are associated with reductions in pre and posttransplant hyperparathyroidism, vitamin D deficiency, and fracture risk after KT. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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