Abstract
BackgroundAccelerated bone loss occurs rapidly following renal transplantation due to intensive immunosuppression and persistent hyperparathyroidism. In renal transplant recipients (RTRs) due to the hyperparathyroidism the non-dominant forearm is often utilized as a peripheral measurement site for dual-energy x-ray absorptiometry (DXA) measurements. The forearm is also the site of previous created distal arteriovenous fistulas (AVF). Although AVF remain patent long after successful transplantation, there are no data available concerning their impact on radial bone DXA measurements.MethodsIn this cross-sectional study we performed DXA in 40 RTRs with preexisting distal AVF (RTRs-AVF) to assess areal bone mineral density (aBMD) differences between both forearms (three areas) and compared our findings to patients with chronic kidney disease (CKD, n = 40), pre-emptive RTRs (RTRs-pre, n = 15) and healthy volunteers (n = 20). In addition, we assessed relevant demographic, biochemical and clinical aspects.ResultsWe found a marked radial asymmetry between the forearms in RTRs with preexisting AVF. The radial aBMD at the distal AVF forearm was lower compared to the contralateral forearm, resulting in significant differences for all three areas analyzed: the Rad-1/3: median (interquartile range) in g/cm2, Rad-1/3: 0.760 (0.641–0.804) vs. 0.742 (0.642, 0.794), p = 0.016; ultradistal radius, Rad-UD: 0.433 (0.392–0.507) vs. 0.420 (0.356, 0.475), p = 0.004; and total radius, Rad-total: 0.603 (0.518, 0.655) vs. 0.599 (0.504, 0.642), p = 0.001). No such asymmetries were observed in any other groups. Lower aBMD in AVF forearm subregions resulted in misclassification of osteoporosis.ConclusionsIn renal transplant recipients, a previously created distal fistula may exert a negative impact on the radial bone leading to significant site-to-site aBMD differences, which can result in diagnostic misclassifications.
Highlights
Accelerated bone loss occurs rapidly following renal transplantation and is associated with considerable fracture risk compared to other chronic kidney disease (CKD) patients [1,2]
The radial areal bone mineral density (aBMD) at the distal arteriovenous fistulas (AVF) forearm was lower compared to the contralateral forearm, resulting in significant differences for all three areas analyzed: the Rad-1/3: median in g/cm2, Rad-1/3: 0.760 (0.641–0.804) vs. 0.742 (0.642, 0.794), p = 0.016; ultradistal radius, Rad-UD: 0.433 (0.392–0.507) vs. 0.420 (0.356, 0.475), p = 0.004; and total radius, Rad-total: 0.603 (0.518, 0.655) vs. 0.599 (0.504, 0.642), p = 0.001)
A previously created distal fistula may exert a negative impact on the radial bone leading to significant site-to-site aBMD differences, which can result in diagnostic misclassifications
Summary
Accelerated bone loss occurs rapidly following renal transplantation and is associated with considerable fracture risk compared to other chronic kidney disease (CKD) patients [1,2]. A peripheral cortical-rich bone, is one of the preferred measuring site for assessing catabolic skeletal effects of hyperparathyroidism and is predictive for fracture risk in CKD patients [12,13,14,15,16]. The non-dominant forearm is often utilized as a peripheral measuring site in renal transplant recipients with persistent hyperparathyroidism. No studies in RTRs have been ever conducted investigating the influence of a previously created radiocephalic AVF on peripheral radial bone aBMD measurements and potential diagnostic misclassifications. In renal transplant recipients (RTRs) due to the hyperparathyroidism the non-dominant forearm is often utilized as a peripheral measurement site for dual-energy x-ray absorptiometry (DXA) measurements. AVF remain patent long after successful transplantation, there are no data available concerning their impact on radial bone DXA measurements
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