Effect of kidney donation on bone mineral metabolism
Authors
Hiemstra, Thomas F.
Smith, Jane C.
Xu, Dihua
Kulkarni, Shreya
Bradley, J. Andrew
Paapstel, Kaido
Schoenmakers, Inez
Bradley, John R.
Tomlinson, Laurie
McEniery, Carmel M.
Wilkinson, Ian B.
Publication Date
2020-07-07Journal Title
PLOS ONE
Publisher
Public Library of Science
Volume
15
Issue
7
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Hiemstra, T. F., Smith, J. C., Lim, K., Xu, D., Kulkarni, S., Bradley, J. A., Paapstel, K., et al. (2020). Effect of kidney donation on bone mineral metabolism. PLOS ONE, 15 (7)https://doi.org/10.1371/journal.pone.0235082
Abstract
Kidney donation results in reductions in kidney function and lasting perturbations in phosphate homeostasis, which may lead to adverse cardiovascular sequelae. However, the acute effects of kidney donation on bone mineral parameters including regulators of calcium and phosphate metabolism are unknown. We conducted a prospective observational controlled study to determine the acute effects of kidney donation on mineral metabolism and skeletal health. Biochemical endpoints were determined before and after donation on days 1, 2 and 3, 6 weeks and 12 months in donors and at baseline, 6 weeks and 12 months in controls. Baseline characteristic of donors (n = 34) and controls (n = 34) were similar: age (53±10 vs 50±14 years, p = 0.33), BMI (26.3±2.89 vs 25.9±3.65, p = 0.59), systolic BP (128±13 vs 130±6 mmHg, p = 0.59), diastolic BP (80±9 vs 81±9 mmHg, p = 0.68) and baseline GFR (84.4±20.2 vs 83.6±25.2 ml/min/1.73m2, p = 0.89). eGFR reduced from 84.4±20.2 to 52.3±17.5 ml/min/1.73m2 (p<0.001) by day 1 with incomplete recovery by 12 months (67.7±22.6; p = 0.002). Phosphate increased by day 1 (1.1(0.9–1.2) to 1.3(1.1–1.4) mmol/L, p <0.001) but declined to 0.8(0.8–1.0) mmol/L (p<0.001) before normalizing by 6 weeks. Calcium declined on day 1 (p = 0.003) but recovered at 6 weeks or 12 months. PTH and FGF-23 remained unchanged, but α-Klotho reduced by day 1 (p = 0.001) and remained low at 6 weeks (p = 0.02) and 1 year (p = 0.04). In this study, we conclude that kidney donation results in acute disturbances in mineral metabolism characterised by a reduced phosphate and circulating α-Klotho concentration without acute changes in the phosphaturic hormones FGF23 and PTH.
Keywords
Research Article, Biology and life sciences, Medicine and health sciences, Physical sciences
Identifiers
pone-d-20-01671
External DOI: https://doi.org/10.1371/journal.pone.0235082
This record's URL: https://www.repository.cam.ac.uk/handle/1810/307723
Rights
Licence:
http://creativecommons.org/licenses/by/4.0/