Risk factors for nonvertebral bone fractures in kidney transplant recipients: a complex reality?

  • Luis Roberto León Instituto de Trasplantes y Alta Complejidad (ITAC) - Diaverum, Buenos Aires, Argentina
  • Olga Elena Guardia Instituto de Trasplantes y Alta Complejidad (ITAC) - Diaverum, Buenos Aires, Argentina
  • Ana Uriona Angulo Instituto de Trasplantes y Alta Complejidad (ITAC) - Diaverum, Buenos Aires, Argentina
  • Anelisse Rivero Arauz Instituto de Trasplantes y Alta Complejidad (ITAC) - Diaverum, Buenos Aires, Argentina
  • Alejandro Suwezda Cátedra de Bioestadística, Universidad del Salvador (USAL), Buenos Aires, Argentina
  • Lidia Moya Vidal Instituto de Trasplantes y Alta Complejidad (ITAC) - Diaverum, Buenos Aires, Argentina
  • Patricia Vega Instituto de Trasplantes y Alta Complejidad (ITAC) - Diaverum, Buenos Aires, Argentina
  • Javier Walther Instituto de Trasplantes y Alta Complejidad (ITAC) - Diaverum, Buenos Aires, Argentina
Keywords: renal transplant, morbidity and mortality, risk factors, non-vertebral bone fractures

Abstract

Introduction: Fractures in renal postransplantation represent one of the complications that increase morbidity and mortality in patients. Objective: To determine the risk factors for transplantation of non-vertebral fractures in renal transplant recipients. Methods: The data of clinical histories of 737 renal transplanted patients since 2009-2015 were analyzed, where the risk factors of fractures were evaluated. They were determined as general factors: age, sex; and specific factors: etiology of chronic kidney disease (ERC), dialysis time, dialysis modality, donor characteristics: age, sex, type of donor, living or cadaveric (DV, DC), different immunosuppression treatments, rejections, treatment with steroid pulses, use of bisphosphonates and biochemical parameters like intact parathormone (PTHI), Pro -Vitamin D (25OHD) and Creatininemia (CREATS). Exclusion criteria: patients <18 years, retransplantation or double transplants and follow-up less than 1 year. Results: 44 patients presented 50 non-vertebral fractures. 62% of the fractures were presented in the first 3 years of the transplant. In the multivariate model it was observed that the general risk factors associated with fracture risk were the advanced age of the receptor (aHR per year increases 1.03, 95% CI: 1.00-1.05] and the female sex (aHR = 1.60, 95% CI: 0.85-2.99), while the specific risk factors were dialysis time (1.07 IC95%: 1.02-1.12), the higher age of the donor (1.03 IC95: 1,00-1,05) and the deficit of 25OHD (3.17 IC95: 1.57-6.41). Conclusions: This study allowed to evaluate predictive factors of fracture in our patients with kidney transplantation.

References

1) Ramsey-Goldman R, Dunn JE, Dunlop DD, Stuart FP, Abecassis MM, Kaufman DB, et al. Increased risk of fracture in patients receiving solid organ transplants. J Bone Miner Res. 1999;14(3):456-63. doi: 10.1359/jbmr.1999.14.3.456.

2) Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int. 2001;12(4):271-8. doi: 10.1007/s001980170116.

3) Malluche HH, Monier-Faugere MC, Herberth J. Bone disease after renal transplantation. Nat Rev Nephrol. 2010;6(1):32-40. doi: 10.1038/nrneph.2009.192.

4) Brandenburg VM, Politt D, Ketteler M, Fassbender WJ, Heussen N, Westenfeld R, et al. Early rapid loss followed by long-term consolidation characterizes the development of lumbar bone mineral density after kidney transplantation. Transplantation. 2004;77(10):1566-71. doi: 10.1097/01.tp.0000131990.13277.28.

5) Nikkel LE, Hollenbeak CS, Fox EJ, Uemura T, Ghahramani N. Risk of fractures after renal transplantation in the United States. Transplantation. 2009;87(12):1846-51. doi: 10.1097/TP.0b013e3181a6bbda.

6) Evenepoel P, Claes K, Meijers B, Laurent MR, Bammens B, Naesens M, et al. Natural history of mineral metabolism, bone turnover and bone mineral density in de novo renal transplant recipients treated with a steroid minimization immunosuppressive protocol. Nephrol Dial Transplant. 2020;35(4):697-705. doi: 10.1093/ndt/gfy306.

7) Naylor KL, Li AH, Lam NN, Hodsman AB, Jamal SA, Garg AX. Fracture risk in kidney transplant recipients: a systematic review. Transplantation. 2013;95(12):1461-70. doi: 10.1097/TP.0b013e31828eead8.

8) Antúnez, P, Man Z. Incidencia de osteoporosis en una muestra de población de la ciudad de Buenos Aires derivada para su estudio. Rev Argent Endocrinol Metab. 1999;47:121.

9) Conley E, Muth B, Samaniego M, Lotfi M, Voss B, Armbrust M, et al. Bisphosphonates and bone fractures in long-term kidney transplant recipients. Transplantation. 2008;86(2):231-7. doi: 10.1097/TP.0b013e318176b40f.

10) Abbott KC, Oglesby RJ, Hypolite IO, Kirk AD, Ko CW, Welch PG, et al. Hospitalizations for fractures after renal transplantation in the United States. Ann Epidemiol. 2001;11(7):450-7. doi: 10.1016/s1047-2797(01)00226-5.

11) Opelz G, Döhler B. Association of mismatches for HLA-DR with incidence of posttransplant hip fracture in kidney transplant recipients. Transplantation. 2011;91(1):65-9. doi: 10.1097/tp.0b013e3181fa94d6.

12) Evenepoel P, Claes K, Meijers B, Laurent MR, Bammens B, Naesens M, et al. Bone mineral density, bone turnover markers, and incident fractures in de novo kidney transplant recipients. Kidney Int. 2019;95(6):1461-70. doi: 10.1016/j.kint.2018.12.024.

13) Altman AM, Sprague SM. Mineral and bone disease in kidney transplant recipients. Curr Osteoporos Rep. 2018;16(6):703-11. doi: 10.1007/s11914-018-0490-4.

14) Perrin P, Kiener C, Javier RM, Braun L, Cognard N, Gautier-Vargas G, et al. Recent changes in chronic kidney disease-mineral and bone disorders and associated fractures after kidney transplantation. Transplantation. 2017;101(8):1897-1905. doi: 10.1097/TP.0000000000001449.

15) León L, Uriona A, Hidalgo J, Condori L, Guardia O, Chuluyan E, et al. Four years follow-up in kidney transplant patients with vascular calcifications Am J Transplant. 2017;17(suppl 3).

16) Nikkel LE, Mohan S, Zhang A, McMahon DJ, Boutroy S, Dube G, et al. Reduced fracture risk with early corticosteroid withdrawal after kidney transplant. Am J Transplant. 2012;12(3):649-59. doi: 10.1111/j.1600-6143.2011.03872.x.

17) McGregor R, Li G, Penny H, Lombardi G, Afzali B, Goldsmith DJ. Vitamin D in renal transplantation - from biological mechanisms to clinical benefits. Am J Transplant. 2014;14(6):1259-70. doi: 10.1111/ajt.12738.

18) Torres A, Torregrosa V, Marcen R, Campistol JM, Arias M, Hernández D, Fernández C, et al. Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study). Nefrologia. 2016;36(3):255-67. doi: 10.1016/j.nefro.2016.03.004.

19) Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (2011). 2017;7(1):1-59. doi: 10.1016/j.kisu.2017.04.001.

20) Carlini RG, Rojas E, Weisinger JR, Lopez M, Martinis R, Arminio A, et al. Bone disease in patients with long-term renal transplantation and normal renal function. Am J Kidney Dis. 2000;36(1):160-6. doi: 10.1053/ajkd.2000.8289.

21) Grotz WH, Mundinger FA, Gugel B, Exner VM, Kirste G, Schollmeyer PJ. Bone mineral density after kidney transplantation. A cross-sectional study in 190 graft recipients up to 20 years after transplantation. Transplantation. 1995;59(7):982-6.

22) Ball AM, Gillen DL, Sherrard D, Weiss NS, Emerson SS, Seliger SL, et al. Risk of hip fracture among dialysis and renal transplant recipients. JAMA. 2002;288(23):3014-8. doi: 10.1001/jama.288.23.3014.
Published
2021-12-02
How to Cite
1.
León LR, Guardia OE, Uriona Angulo A, Rivero Arauz A, Suwezda A, Moya Vidal L, Vega P, Walther J. Risk factors for nonvertebral bone fractures in kidney transplant recipients: a complex reality?. Rev Nefrol Dial Traspl. [Internet]. 2021Dec.2 [cited 2024Dec.21];41(4):235-42. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/707
Issue
Vol. 41 No. 4 (2021): Oct. - Dic.
Section
Original Article

Copyright (c) 2021 Revista de Nefrología, Diálisis y Trasplante

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.