Successful Renal Transplantation, Bone Mineral Densitometry, and Affecting Factors.

BACKGROUND: Successful renal transplantation corrects many disorders of bone and mineral metabolism owing to the normalization of serum levels of calcium and phosphorus and restoration of calcitriol production. However, successful transplantation does not guarantee complete resolution of the pre-transplantation osteopathy. METHODS: This study evaluated 100 patients who underwent successful renal transplantation. We determined the possible risk factors for osteoporosis among 72 male and 28 female renal transplant patients of mean age 32.3 ± 10.0 years with 81% of them recipients of living-related grafts. Bone mineral densitometry (BMD) was performed in all patients before and ≥ 1 year after transplantation. Routine test results and demographic data were recorded. RESULTS: At the time of transplantation 76% of the patients had osteoporosis or osteopeni and only 24% of them had normal BMD in 4 regions (femur neck, lumber, radius, and ultradistal). After transplantation, 70% of them had osteopororosis or osteopeni and 30% were normal. After renal transplantation, BMD scores increased (P > .05) although the diagnosis of the bone disease did not change (P < .05). Only preexisting osteodystrophy and smoking were found to be important risk factors for post-transplantation osteoporosis. CONCLUSIONS: After renal transplantation, BMD scores increased whereas the diagnosis of bone disease did not change statistically. We found that medical management of osteopenia/osteoporosis before transplantation and smoking habit are the main factors to prevent post-transplantation osteoporosis. Further long-term studies may be more helpful for evaluating the risk factors of post-transplantation osteoporosis.

Male sexual function in patients receiving different types of renal replacement therapy.

BACKGROUND: Patients with end-stage renal disease (ESRD) experience erectile dysfunction (ED). Although it is a benign disorder, ED is related to physical and psychosocial health, and it has a significant impact on the quality of life (QOL). The objective of the present study was to investigate the effects of different renal replacement therapies on ED. METHODS: A total of 100 ESRD patients and 50 healthy men were recruited to the present cross-sectional study. The study was consisted of 53 renal transplantation (RT; group I; mean age, 39.01 ± 7.68 years; mean duration of follow-up, 97.72 ± 10.35 months) and 47 hemodialysis (HD) patients (group II; mean age, 38.72 ± 9.12 years; mean duration of follow-up, 89.13 ± 8.65 months). The control group consisted of 50 healthy men (group III; mean age 39.77 ± 8.51 years). Demographic data and laboratory values were obtained. All groups were evaluated with the following scales: International Index of Erectile Function (IIEF)-5 and Short Form (SF)-36 questionnaires, and Beck Depression Inventory (BDI). The patients whose IIEF score were ≤ 21 were accepted as having ED. RESULTS: The mean age of these groups were similar (P > .05). Total IIEF-5 scores of men in groups I, II, and III were 19.5 ± 4.5, 16.4 ± 5.9, and 22.5 ± 3.4, respectively. The mean total IIEF-5 score of control group was higher than those of groups I and II (P < .001). Posttransplant group mean total IIEF-5 score was also higher than the HD group (P < .05). Groups I and II significantly differed from control group in terms of presence of ED (IIEF score ≤ 21: Group I, n = 28 [52.8%]; group II, n = 29 [61.7%]; and group III, n = 12 [%24], respectively [P < .001]), whereas there was no difference between groups I and II. In the logistic regression analysis (variables included age, BDI, and renal replacement therapy [HD and transplantation]), ED was independently associated with age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.05-1.2), BDI (OR, 1.1; 95% CI, 1.01-1.13). Additionally, ED was not associated with renal replacement therapy (OR, 1.46; 95% CI, 0.60-3.57). Physiologic health domain of SF-36 was significantly better in healthy controls (P < .001). Patient groups were similar in terms of BDI score (P > .05). ED score was negatively correlated with BDI (r = -0.368; P < .001), and positively correlated with SF-36 (r = 0.495; P < .001) in all patient groups. CONCLUSION: Patients with ESRD had significantly lower sexual function and lower QOL scores than the healthy control men. Notably, the mode of renal replacement therapy had no impact on male sexual function.

Vitamin D status, bone mineral density, and inflammation in kidney transplantation patients.

Vitamin D has immunomodulatory and anti-inflammatory activities in the healthy population and in various disease states. There are few data on the quantification of vitamin D status and inflammation with respect to changes in bone mineral density among renal transplantation patients. We analyzed the influence of vitamin D levels on allograft function and inflammatory status at the time of enrollment and at 1-year follow-up. Sixty-four renal transplant patients, including 38 males, showed an overall age of 38.61 +/- 1.05 years, had a mean graft age of 6.15 +/- 3.17 years. We excluded patients who had diabetes mellitus, chronic inflammatory disease, or chronic allograft nephropathy. We obtained pre- and posttransplantation serum samples and daily proteinuria on each patient. Measurements of bone mineral density were performed by dual-energy X-ray absortiometry. After enrollment, we followed the patients for 1 year. Thereafter we assessed serum creatinine, C-reactive protein, albumin, and spot urinary protein levels. The patients were divided into two groups based upon vitamin D levels: group I (n = 29), <20 microg/L versus group II (n = 35), >or=20 microg/L. There was no significant difference in intact parathyroid hormone levels between the two groups. Vitamin D level positively correlated with serum creatinine (r = .32, P = .01) and serum albumin levels (r = .28, P = .023) at the time of enrollment. At 1 year, patients in group I showed significantly higher creatinine (P < .001) and proteinuria levels (P < .05) than those in group II. Low vitamin D levels are not uncommon among renal transplant recipients. There was a significant association of vitamin D levels with renal allograft function. Low vitamin D levels may be a predictor of worsening of graft function and increasing proteinuria.