{"title":"Impact of Potassium-Binders on the Interpretation of Bone Mineral Density Following Kidney Transplantation.","authors":"Anders Åsberg, Karsten Midtvedt, Jørn Petter Lindahl, Hege Pihlstrøm, Jens Bollerslev, Kristin Godang","doi":"10.1111/ctr.70352","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Following kidney transplantation (KTx), episodes of hyperkalemia are common and effectively treated with sodium zirconium cyclosilicate (SZC, Lokelma) or patiromer (PAT, Veltassa). The presence of SZC/PAT in the gastrointestinal tract may, if radio dense, influence the interpretation of lumbar spine (LS) dual-energy x-ray absorptiometry (DXA)-scans. We investigated the effect with/without PAT/SZC in KTx on LS DXA readings.</p><p><strong>Methods: </strong>A prospective, single-center study of KTx recipients in need of potassium-lowering therapy was performed. All participants performed two LS DXA-scans, the first after at least 3 days of SZC/PAT treatment and the second after a 2-week washout.</p><p><strong>Results: </strong>Eighteen KTx patients (8 SZC, 10 g/day vs. 10 PAT, 8.4 g/day) were included and provided two valid DXA-scans (mean age 63 ± 12 years, 12 males). The change in LS BMD determinations in the SZC group was 2.48 ±12.21%, while there was no change in the PAT group, -0.25 ± 2.28%. The absolute root mean squared difference (RMSD) change was 0.102 ± 0.084 g/cm<sup>2</sup> and 0.021 ±0.013 g/cm<sup>2</sup> after SZC and PAT washout, respectively (p = 0.008).</p><p><strong>Conclusion: </strong>In KTx, treatment with SZC, but not PAT, significantly influenced the DXA-scan interpretation of the LS region. After a 2-week washout period, SZC interference was without clinical implications on DXA-scans.</p><p><strong>Summary: </strong>The potassium lowering drug sodium zirconium cyclosilicate (Lokelma) is radiopaque and therefore acts as a confounder on DXA interpretations in kidney transplant recipients. Patiromer (PAT, Veltassa) has no such effect.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":"e70352"},"PeriodicalIF":1.9000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ctr.70352","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Following kidney transplantation (KTx), episodes of hyperkalemia are common and effectively treated with sodium zirconium cyclosilicate (SZC, Lokelma) or patiromer (PAT, Veltassa). The presence of SZC/PAT in the gastrointestinal tract may, if radio dense, influence the interpretation of lumbar spine (LS) dual-energy x-ray absorptiometry (DXA)-scans. We investigated the effect with/without PAT/SZC in KTx on LS DXA readings.
Methods: A prospective, single-center study of KTx recipients in need of potassium-lowering therapy was performed. All participants performed two LS DXA-scans, the first after at least 3 days of SZC/PAT treatment and the second after a 2-week washout.
Results: Eighteen KTx patients (8 SZC, 10 g/day vs. 10 PAT, 8.4 g/day) were included and provided two valid DXA-scans (mean age 63 ± 12 years, 12 males). The change in LS BMD determinations in the SZC group was 2.48 ±12.21%, while there was no change in the PAT group, -0.25 ± 2.28%. The absolute root mean squared difference (RMSD) change was 0.102 ± 0.084 g/cm2 and 0.021 ±0.013 g/cm2 after SZC and PAT washout, respectively (p = 0.008).
Conclusion: In KTx, treatment with SZC, but not PAT, significantly influenced the DXA-scan interpretation of the LS region. After a 2-week washout period, SZC interference was without clinical implications on DXA-scans.
Summary: The potassium lowering drug sodium zirconium cyclosilicate (Lokelma) is radiopaque and therefore acts as a confounder on DXA interpretations in kidney transplant recipients. Patiromer (PAT, Veltassa) has no such effect.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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