| Review article: Managing bone complications after kidney transplantation. | |
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MedLine Citation:
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PMID: 19563386 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Chronic kidney disease mineral and bone disorder (CKD-MBD) describes the laboratory, bone and vascular abnormalities that exist in patients with CKD stages 3-5D and that may persist after transplantation. Persisting abnormalities of bone turnover and abnormal mineralization, together with bone mineral density (BMD) loss from glucocorticoids, may all predispose to a loss of structural integrity and increased fracture risk in kidney and kidney pancreas recipients. Vitamin D, calcitriol, calcitonin and bisphosphonates have all been used to preserve BMD following transplantation, despite a lack of safety data and the potential for some of these drugs to cause harm. A limited number of post-transplant studies utilizing these drugs have not yet documented improved fracture prevention or fracture-related mortality and have not considered allocation based on risk factors for fracture or markers of bone turnover. Targeted allocation of the available therapies based on a stratification of risk appears warranted. This might be achieved using an algorithm incorporating BMD, X-ray evaluation, laboratory investigations including bone turnover markers and the assessment of standard fracture risk factors at the time of and soon after transplantation. This approach, which is similar to protocols used in the general population, may result in more effective management of patients and fewer adverse effects such as adynamic bone disease. Although BMD is a surrogate for fracture risk in the general population it is not validated in this transplant population. Consequently, such an approach should be confirmed by studies that include bone biopsy data and an evaluation of patient level outcomes. |
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Authors:
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Rahul Mainra; Grahame Elder |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Nephrology (Carlton, Vic.) Volume: 14 ISSN: 1440-1797 ISO Abbreviation: Nephrology (Carlton) Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-06-30 Completed Date: 2009-09-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9615568 Medline TA: Nephrology (Carlton) Country: Australia |
Other Details:
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Languages: eng Pagination: 437-42 Citation Subset: IM |
Affiliation:
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Division of Nephrology, St. Paul's Hospital, Saskatoon, Saskatchewan, Canada. rahul.mainra@usask.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Bone Density Bone Diseases / mortality, pathology*, therapy* Humans Kidney Transplantation* Postoperative Complications / mortality, pathology*, therapy* Renal Insufficiency, Chronic / mortality, pathology*, surgery Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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