Jin Kyung Kwon, Yaerim Kim, Jin Hyuk Paek, Kyubok Jin, Seungyeup Han, Woo Yeong Park
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引用次数: 0
Abstract
Background: Denosumab has been reported to improve bone mineral density (BMD), but the clinical impact of denosumab on osteoporosis in kidney transplant recipients (KTRs) remains controversial.
Methods: We analyzed 98 KTRs who used denosumab from 2018 to 2023. We investigated the change in BMD, laboratory findings, complications of denosumab, fracture risk assessment tool (FRAX) score, acute rejection within 1 year, and graft failure.
Results: Mean T-scores at 1 year after denosumab were significantly increased compared to mean T-scores pre-denosumab at the femur neck and spine area, respectively (-2.68 ± 0.68 vs. -2.81 ± 0.68, p < 0.001; -2.78 ± 0.96 vs. -3.21 ± 1.00, p < 0.001). The levels of calcium and phosphorus significantly decreased and those of vitamin D significantly increased at 1 year after denosumab, but there were no significant differences in parathyroid hormone, allograft function, and tacrolimus trough level. There were no recurrent fractures among 12 KTRs with a history of fracture, but three de novo fractures happened. Cardiovascular events occurred in three patients. Denosumab-induced hypocalcemia developed in eight patients, but severe hypocalcemia was observed in only one patient. Acute kidney injury did not happen. Urinary tract infection (UTI) occurred in 17 patients. Arthralgia occurred in four patients. FRAX score was significantly decreased after denosumab. Acute rejection within 1 year after denosumab developed in three patients. There was no graft failure.
Conclusion: The use of denosumab in KTRs is effective and safe for the treatment of osteoporosis and prevention of fracture, but it should be carefully monitored for complications, especially UTI.
背景：据报道，Denosumab可改善骨密度（BMD），但Denosumab对肾移植受者（KTRs）骨质疏松症的临床影响仍存在争议。方法：对2018年至2023年使用denosumab的98例ktr患者进行分析。我们调查了骨密度的变化、实验室结果、denosumab的并发症、骨折风险评估工具（FRAX）评分、1年内急性排斥反应和移植物失败。结果：与denosuumab治疗前相比，denosuumab治疗后1年的股骨颈和脊柱区域平均t评分显著升高(-2.68±0.68 vs -2.81±0.68,p < 0.001；-2.78±0.96 vs -3.21±1.00,p < 0.001)。在denosumab治疗1年后，钙、磷水平显著降低，维生素D水平显著升高，但甲状旁腺激素、异体移植物功能和他克莫司槽水平无显著差异。12例有骨折史的ktr患者无复发骨折，但有3例发生新发骨折。3例患者发生心血管事件。8例患者出现了denosumab诱导的低钙血症，但只有1例患者出现了严重的低钙血症。未发生急性肾损伤。17例患者发生尿路感染。4例患者出现关节痛。denosumab治疗后FRAX评分显著降低。3例患者使用地诺单抗后1年内出现急性排斥反应。没有移植失败。结论：在KTRs中使用denosumab治疗骨质疏松和预防骨折是有效和安全的，但应仔细监测并发症，特别是UTI。
期刊介绍：
Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.
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