ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO165

Effects of Denosumab on Bone Metabolism and Bone Mineral Density in Kidney Transplant Patients: A Meta-Analysis

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Acharya, Prakrati C., University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Thongprayoon, Charat, Bassett Medical Center, Cooperstown, New York, United States
  • Torres Ortiz, Aldo E., University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Gonzalez Suarez, Maria Lourdes, University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Ridgeland, Mississippi, United States
Background

The uses of immunosuppressive agents, are associated with increased risks of bone loss in kidney transplant (KTx) patients. Denosumab, a potent anti-resorptive agent, has been shown to increase bone mineral density (BMD) in patients with CKD. However, its effects on bone metabolism and BMD in KTx patients remain unclear.

Methods

A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through April 2018 to identify studies evaluating the effects of denosumab on changes in bone metabolism and BMD from baseline to post-treatment course in KTx patients. Study results were pooled and analyzed using a random effects model. The protocol for this meta-analysis is registered with PROSPERO (CRD42018095055).

Results

5 studies (a clinical trial and 4 cohort studies) with a total of 162 KTx patients were identified. Majority of patients had baseline eGFR ≥ 30 mL/min/1.73 m2. After the treatment (≥6 to 12 months), there were significant increases in BMD with standardized mean differences (SMDs) of 3.26 (95%CI 0.88-5.64) and 1.83 (95%CI 0.43 to 3.22) for lumbar spine and femoral neck, respectively. There were also significant increases in T scores with SMDs of 0.92 (95%CI 0.58 to 1.25) and 1.14 (95%CI 0.17 to 2.10) for lumbar spine and femoral neck, respectively. There were no significant changes in serum Ca or PTH from baseline to post-treatment course ( ≥ 6 months) with mean differences (MDs) of 0.52 (95%CI, -0.13 to 1.16) mmol/L and -13.24 (95% CI, -43.85 to 17.37) ng/L, respectively. Data from a clinical trial demonstrated that asymptomatic hypocalcemia occurred more common in denosumab group (12 episodes in 39 patients) than in control (1 episode in 42 patients). From cohort studies, the pooled incidence of hypocalcemia following denosumab treatment was 1.7% (95%CI 0.4% to 6.6%). All reported hypocalcemic episodes were mild and asymptomatic, but majority of patients required Ca and Vit D supplements.

Conclusion


Among KTX patients with good allograft function, denosumab effectively increases BMD and T scores in the lumbar spine and femur neck. From baseline to post-treatment, there are no differences in serum Ca and PTH. However, mild hypocalcemia can occur following denosumab treatment, requiring monitoring and titration of Ca and Vit D supplements.