Effects Of Kidney Transplantation On Chronic Kidney Disease-Mineral And Bone Disorder

ObjectiveTo investigate the effect of kidney transplantation on chronic kidney disease(CKD)-mineral and bone metabolism disorders by collecting bone metabolism indexes and bone mineral density(BMD)of kidney transplant patients in our hospital.MethodsA total of 82 kidney transplant patients who were followed up after surgery in the Urology Department of Baogang Hospital of Inner Mongolia from November 2021 to February 2023 were selected.The patient’s age,gender,female menopause,height,weight,body mass index,smoking history,drinking history,preoperative dialysis method and dialysis duration,transplantation age,drug treatment and other medical history were collected.The results of routine blood test,liver and kidney function,calcium,phosphorus,vitamin D,alkaline phosphatase and parathyroid hormone were collected.Dual-energy X-ray absorptiometry was used to measure the bone mineral density of lumbar 1 to lumbar 4 and the left and right hip joints.1.Osteoporosis and osteopenia were divided into abnormal bone mass group,and normal bone mass group was divided into control group.2.The patients were divided into three groups according to the age of transplantation: 12 months or less,12-36 months,and more than 36 months.The bone metabolism indexes and bone mineral density of each part were compared.3.Estimated glomerular filtration rate(egfr)was calculated based on serum creatinine and age using Chinese simplified MDRD formula.The patients were divided into three groups: e GFR < 30ml/min/1.73m2,30ml/min/1.73m2≤e GFR < 60ml/min/1.73m2,60ml/min/1.73m2 ≤e GFR.The bone metabolism indexes and bone mineral density of each part were compared.4.The bone mineral density values of different parts of patients were compared by the occurrence of hypophosphatemia,hypercalcemia,vitamin D deficiency or insufficiency,and PTH elevation.5.With bone loss as the dependent variable,variables such as age,height,ALP,and preoperative dialysis duration were included in the multivariate Logistic regression equation.SPSS26.0 statistical software was used to analyze the data.Results1.According to the results of bone mineral density,the patients were divided into abnormal bone mass group and normal bone mass group.The basic information and laboratory test results of the two groups were compared and analyzed,and the results showed that: The results showed that there were significant differences in age,height,preoperative dialysis duration and ALP between the abnormal bone mass group and the normal bone mass group(P < 0.05).The bone loss group was older,the preoperative dialysis duration was longer,the ALP was higher and the height was shorter.There were no significant differences in gender,female menopause,dialysis mode,smoking history,drinking history,kidney source,type of immunosuppressant,transplant age,body weight,BMI,e GFR,Ca,P,PTH,and 25-OH-D between the abnormal bone mass group and the normal bone mass group(P > 0.05).2.According to the age of transplantation,the patients were divided into three groups: 12 months and less,12 months to 36 months,and more than 36 months.The bone metabolism indexes and bone mineral density of the three groups were compared and analyzed.3.According to the estimated glomerular filtration rate(e GFR),the patients were divided into e GFR < 30ml/min/1.73m2,30ml/min/1.73m2 ≤e GFR < 60ml/min/1.73m2,60ml/min/1.73m2≤e GFR groups.The bone metabolism indexes and bone mineral density values of the three groups were compared and analyzed.The results showed that: The level of25-hydroxyvitamin D in e GFR < 30ml/min/1.73m2 group was lower than that in30ml/min/1.73m2≤eGFR < 60ml/min/1.73m2 group and e GFR≥60 ml/min/1.73m2 group,and the difference was statistically significant(P < 0.05).4.According to the occurrence of hypophosphatemia,hypercalcemia,vitamin D deficiency or insufficiency,and PTH elevation,the BMD of each site was compared between the hypercalcemia group and the normal serum calcium group.The BMD of bilateral femoral neck in the hypercalcemia group was lower than that in the normal serum calcium group,and the difference was statistically significant(P < 0.05).There was no significant difference in BMD between hypophosphatemia group and normal serum phosphorus group(P > 0.05).The BMD of lumbar spine and bilateral femoral neck in the vitamin D insufficiency group were lower than those in the vitamin D deficiency group and the normal vitamin D group,and the difference was statistically significant(P < 0.05).Compared with the normal PTH group,the BMD of lumbar spine and left femoral neck in the high PTH group were lower than that in the normal PTH group,and the difference was statistically significant(P < 0.05).5.With bone loss as the dependent variable,variables such as age,height,ALP,and preoperative dialysis duration were included in the multivariate Logistic regression equation.The results showed that age and increased alkaline phosphatase(ALP)were risk factors for bone loss,with statistical significance(P < 0.05).Conclusion1.Age,duration of preoperative dialysis and alkaline phosphatase are associated with osteopenia;2.Graft age had no effect on bone metabolism and bone mineral density;3.Vitamin D deficiency may be caused by decreased graft function;4.The occurrence of hypercalcemia,vitamin D deficiency and hyperparathyroidism is related to the decrease of bone mineral density;5.by Logistic multivariate regression,age and elevated ALP were high risk factors for osteopenia.