Bone health in autosomal dominant polycystic kidney disease (ADPKD) patients after kidney transplantation
Dalia Zubidat,
Christian Hanna,
Amarjyot K. Randhawa,
Byron H. Smith,
Maroun Chedid,
Daniel-Hasan N. Kaidbay,
Luca Nardelli,
Yaman G. Mkhaimer,
Reem M. Neal,
Charles D. Madsen,
Sarah R. Senum,
Adriana V. Gregory,
Timothy L. Kline,
Ziad M. Zoghby,
Stephen M. Broski,
Naim S. Issa,
Peter C. Harris,
Vicente E. Torres,
Jad G. Sfeir,
Fouad T. Chebib
Affiliations
Dalia Zubidat
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Christian Hanna
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pediatric Nephrology and Hypertension, Department of Pediatric Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
Amarjyot K. Randhawa
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Byron H. Smith
Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
Maroun Chedid
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Daniel-Hasan N. Kaidbay
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Luca Nardelli
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Yaman G. Mkhaimer
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Reem M. Neal
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Charles D. Madsen
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Sarah R. Senum
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Adriana V. Gregory
Department of Radiology, Mayo Clinic, Rochester, MN, USA
Timothy L. Kline
Department of Radiology, Mayo Clinic, Rochester, MN, USA
Ziad M. Zoghby
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Stephen M. Broski
Department of Radiology, Mayo Clinic, Rochester, MN, USA
Naim S. Issa
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Peter C. Harris
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
Vicente E. Torres
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Jad G. Sfeir
Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
Fouad T. Chebib
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA; Corresponding author at: 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
ADPKD is caused by pathogenic variants in PKD1 or PKD2, encoding polycystin-1 and -2 proteins. Polycystins are expressed in osteoblasts and chondrocytes in animal models, and loss of function is associated with low bone mineral density (BMD) and volume. However, it is unclear whether these variants impact bone strength in ADPKD patients. Here, we examined BMD in ADPKD after kidney transplantation (KTx). This retrospective observational study retrieved data from adult patients who received a KTx over the past 15 years. Patients with available dual-energy X-ray absorptiometry (DXA) of the hip and/or lumbar spine (LS) post-transplant were included. ADPKD patients (n = 340) were matched 1:1 by age (±2 years) at KTx and sex with non-diabetic non-ADPKD patients (n = 340). Patients with ADPKD had slightly higher BMD and T-scores at the right total hip (TH) as compared to non-ADPKD patients [BMD: 0.951 vs. 0.897, p < 0.001; T-score: −0.62 vs. -0.99, p < 0.001] and at left TH [BMD: 0.960 vs. 0.893, p < 0.001; T-score: −0.60 vs. -1.08, p < 0.001], respectively. Similar results were found at the right femoral neck (FN) between ADPKD and non-ADPKD [BMD: 0.887 vs. 0.848, p = 0.001; T-score: −1.20 vs. -1.41, p = 0.01] and at left FN [BMD: 0.885 vs. 0.840, p < 0.001; T-score: −1.16 vs. -1.46, p = 0.001]. At the LS level, ADPKD had a similar BMD and lower T-score compared to non-ADPKD [BMD: 1.120 vs. 1.126, p = 0.93; T-score: −0.66 vs. -0.23, p = 0.008]. After adjusting for preemptive KTx, ADPKD patients continued to have higher BMD T-scores in TH and FN. Our findings indicate that BMD by DXA is higher in patients with ADPKD compared to non-ADPKD patients after transplantation in sites where cortical but not trabecular bone is predominant. The clinical benefit of the preserved cortical bone BMD in patients with ADPKD needs to be explored in future studies.
