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Abstract: TH-PO154

How Do We Treat Mineral Bone Disease After Transplantation? A Single-Centre Experience

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Coupe, Thomas Blaye, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Montero, Francisco, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Calayag, Rouven, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Montero, Rosa M., St George's University Hospitals NHS Foundation Trust, London, United Kingdom
Background

Mineral bone disease (MBD) causes increased morbidity and mortality. Previous studies report resolution of hyperparathyroidism in 30% of kidney transplant recipients (KTR) after 1 year and 57% 2 years post transplantation. Current guidelines recommend different strategies of treating hyperparathyroidism without guidance on de-escalation of therapy post transplant. Some centres stop all MBD treatment at the time of transplantation. We looked to determine what medical treatments our KTR were taking for management of MBD.

Methods

A cross-sectional retrospective observational study of all KTR at our centre between 2021-2022 were included. Clinical outcome data was collected from electronic patient records including medications were grouped into; Cinacalcet, Alfacalcidol, Vitamin D3(VitD3) and/or combinations of these for treatment of MBD. The length of time KTR were on these medications and biochemical data was collected. Paired t-tests and ANOVA were used to perform statistical analysis with a p<0.05 significant level.

Results

There were 509 KTR between 2021-2022. 9 were excluded due to missing data. 275 male, 225 female with a median age 56yrs (21-87yrs). 500 KTR; 2% were on Cinacalcet, 4% Cinacalcet+Alfacalcidol, 1% Cinacalcet+Alfacalcidol+VitD3, 30% Alfacalcidol, 15% Alfacalcidol+VitD3, 21% VitD3 and 27% on none. Mean time after transplantation was; 8.1yrs, 6.4yrs, 7.1yrs, 7.7yrs,10.6yrs, 10.7yrs and 10.6yrs, respectively. Mean Creatinine was significantly different between the 2021 and 2022 in the different treatment groups (p<0.04) with no significant changes in mean GFR. Mean Creatinine in all the groups except the cinacalcet alone decreased. Those on Cinacalcet+Alfacalcidol or Cinacalcet+Alfacalcidol+VitD3 had the highest creatinine's that decreased from 2021 to 2022. Mean PTH (pmol/L) levels decreased from 2021-2022 in all of the groups (11.7-10.7, 36-14.2, 71.8-61.3, 16.2-13.1, 12-8, 10-9, 9.2-8.7, respectively, p<0.05). Calcium adjusted (CA) levels were lower in the Alfacalcidol+VitD3 and VitD3 groups alone (2.0mmol/L). Mean Phosphate levels remain unchanged. Phosphate binders were used in all groups except Cinacalcet and VitaminD3.

Conclusion

A range of combination therapies are used for MBD management. We propose a de-escalation of therapy post transplantation guidance will reduce polypharmacy. Limitation is a single centre experience.