Abstract: FR-PO164
Intact FGF-23, Intact PTH, and Other CKD-MBD Markers After Successful Living Renal Transplantation: A Longitudinal Study
Session Information
- Bone and Mineral Metabolism: Phosphorus, FGF23, Vascular Calcification
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Author
- Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, DElhi, India
Background
Markers of CKD-MBD cause LVH & CV mortality. Compared to general population CV mortality remain high post RT. MBD abnormalities post RT can be due to persistence of CKD induced abnormalities or can develop de novo due to immunosuppressive drugs & lower GFR & may contribute to increased CV mortality. Though, few studies have prospectively looked at MBD markers post RT, their course in post RT period remains poorly defined particularly in patients receiving living donor RT (LDRT) where renal function normalizes faster. This prospective, longitudinal study analyses serial changes in these variables pre & post LDRT
Methods
83 consecutive & consenting adults aged 18-65 years undergoing first LDRT were enrolled. Investigations were done pre-RT & at 1, 6 & 12 months post RT. Patients with diabetes & those having persistent eGFR <40 ml/min post RT were excluded
Results
74 patients completed study. 91.8% were male, mean age was 35.5+10.6 years & median dialysis vintage was 14 months. Basic disease was presumed CTID in 45.9% & presumed CGN in 39.1%. All were on 3-drug immunosuppression of MMF, steroids & CNIs. Intact FGF 23 was assayed using ELISA method (Kainos Labs Japan). 25-OH Vit D levels & iPTH levels were measured by chemiluminescence method (Abbott Labs, IL USA)
Table shows study parameters at baseline & their course post RT. Taking standard cut-off values: 7% patients had hypocalcemia while 3% had hypercalcemia before RT while none in post RT period had hypo or hypercalcemia. Before RT 97% had hyperphosphatemia while 32.3, 4 & 0% had hypophosphatemia at 1,6 & 12 months post RT. 100% patients had hyperparathyoidism pre RT while 64.8, 24.3 &10.7% had hyperparathroidism at 1,6 & 12 months post RT. 100% patients had high iFGF 23 levels pre RT while 36.4, 12. & 0% had increased iFGF23 levels at 1, 6 & 12 months post RT
Conclusion
In younger CKD-5D cohort having shorter dialysis vintage who underwent LDRT we document rapid & significant decline in iPTH & iFGF 23 levels post RT. iFGF23 normalised faster as compared to iPTH
| Parameter | Baseline | 1 month | 6 month | 12 month | Friedman test (p) |
| eGFR ml/min | 8.4±4.1 | 88.1 + 36.5 | 72.6 + 20.4 | 74.9 + 21.8 | 0.001 |
| S. Calcium mg/dl | 8.9±1.4 | 9.1±0.6 | 9±0.8 | 9±0.6 | 0.3 |
| S. Phosphorus mg/dl | 5±1.6 | 2.9±0.8 | 3.1±0.7 | 3.3±0.6 | 0.001 |
| Intact PTH pg/dl | 370.4±226.2 | 110.6±86.4 | 87.8±65.9 | 53.7±22.2 | 0.001 |
| Intact FGF-23 pg/dl | 2652.5±910.4 | 72.2±68.1 | 48.2±39.3 | 42.6±16.8 | 0.001 |
| Serum 25 (OH) Vitamin D ng/dl | 10.5±8.2 | 10.7±7.1 | 11.3±6.2 | 11.5±7.2 | 0.7 |