부산대학교 도서관

Renal transplantation is the preferred renal replacement therapy type in end-stage renal disease. (1) In addition to the improvement in renal function after a successful transplant, anemia, secondary hyperparathyroidism, and [...]
Objective: Kidney transplant recipients are at risk of losing bone mineral density. Osteoporosis and fractures cause serious complications in renal transplant recipients. We aimed to evaluate the efficacy and safety of bisphosphonate and denosumab treatments. Methods: Thirty-two renal transplant patients with osteoporosis from Division of Nephrology of Istanbul University-Cerrahpasa were retrospectively evaluated. Ten patients were treated with denosumab, 22 patients were treated with bisphosphonate. Time elapsed after transplantation, cumulative steroid doses, baseline and first-year calcium, phosphorus, parathyroid hormone, and the glomerular filtration rate were compared. The initial and first-year femur and lumbar bone mineral densities were compared for both groups separately. Results: The baseline femur bone mineral density was significantly lower in the denosumab arm, but there was no significant difference between the initial lumbar bone mineral densities between groups. There was a significant increase in lumbar bone mineral density for both the denosumab and bisphosphonate arms in the first year of treatment. For both groups, there was no significant increase in femur bone mineral density in the first year of treatment. The time elapsed after transplantation and cumulative steroid dose were higher in the denosumab arm. Glomerular filtration rate levels of the denosumab arm were lower compared to bisphosphonate arm. Hypocalcemia associated with antiresorptive agent was not found in the treatment arms. In the first year of treatment, calcium levels were significantly lower in the denosumab treatment arm. Conclusion: Denosumab is an effective treatment option, especially in renal transplant patients with a low glomerular filtration rate. Keywords: Denosumab, kidney transplantation, osteoporosis, transplant recipients Amac: Renal transplant alicilarinda kemik mineral yogunlugunun (KMY) azalma riski vardir. Osteoporoz ve osteoporoza bagli kiriklar ciddi komplikasyonlara neden olabilirler. Bu calismada denosumab ve bifosfonatin etkinligini ve guvenilirligini degerlendirmeyi amacladik. Yontemler: Istanbul Universitesi-Cerrahpasa Nefroloji Bilim Dali'nda takipli osteoporozu olan 32 renal transplant alicisi retrospektif olarak incelendi. Hastalardan 10'u denosumab ile 22'si bifosfonat ile tedavi aliyordu. Hastalarin transplantasyondan sonraki sureleri, kumulatif steroid dozlari, baslangic ve birinci yil kalsiyum, fosfor, paratiroid hormon ve glomeruler filtrasyon hizlari (GFR) karsilastirildi. Baslangic ve birinci yil femur ve lomber KMY degerleri grup icinde ve gruplararasi karsilastirildi. Bulgular: Denosumab tedavi kolunda baslangic femur KMY degerleri anlamli olarak daha dusuk saptandi, ancak lomber KMY degerleri arasinda anlamli bir fark saptanmadi. Tedavinin ilk yilinda her iki tedavi kolunda lomber KMY degerlerinde anlamli bir artis saptanirken femur KMY degerlerinde anlamli bir artis olmadi. Transplantasyondan sonraki sure ve kumulatif steroid dozlari denosumab tedavi kolunda anlamli olarak daha yuksekti. Denosumab tedavi kolunda baslangic GFR anlamli olarak daha dusuktu. Tedavi kollarinda antirezorptif ajanla iliskili hipokalsemi saptanmadi. Tedavinin birinci yilinda, denosumab tedavi kolunda kalsiyum duzeyleri anlamli olarak daha dusuk saptandi. Sonuc: Denosumab tedavisi, ozellikle dusuk GFR'ye sahip renal transplant hastalarinda etkili ve guvenilir bir tedavi secenegidir. Anahtar Kelimeler: Denosumab, osteoporoz, renal transplantasyon, transplant alicilari