The relationship between the Spine Deformity Index, biochemical parameters of bone metabolism and vascular calcifications: results from the Epidemiological VERtebral FRACtures iTalian Study (EVERFRACT) in dialysis patients.

BACKGROUND: The Spine Deformity Index (SDI) is a measure of vertebral fractures (VFs), providing information on both their number and severity. METHODS: We evaluated the relationships between SDI and clinical, biochemical and arterial calcification parameters in 387 hemodialysis (HD) patients. VFs, assessed by quantitative vertebral morphometry, and vascular calcifications were identified in the same lateral spinal X-ray. To improve the detection of fracture severity, we created a corrected SDI (c-SDI), by dividing SDI for the number of VFs. We assessed routine biochemistry, bone-Gla-protein (BGP), undercaboxylated BGP (ucBGP), and matrix-Gla-protein (MGP). RESULTS: VFs prevalence was 55.3%. HD patients with a SDI >1 were more frequently males (p<0.05), and had lower BGP (p<0.01). Patients with a c-SDI >1 had higher LDL-cholesterol (p<0.05) and lower ucBGP (p<0.05) and MGP (p<0.05). Calcifications of the abdominal aorta (AAoC) were more frequent in patients with SDI >1 (p<0.05) and with c-SDI >1 (p<0.05). Multivariate logistic regression showed that male sex (OR 1.86, CI 1.20-2.91), age (OR 1.03, CI 1.01-1.05) and albumin ≥3.5 g/dL (OR 0.54, CI 0.31-0.93) were predictors of a SDI >1. Age (OR 1.05, CI 1.03-1.07), LDL-cholesterol (OR 1.74, CI 1.04-2.92) and ucBGP (OR 0.35, CI 0.18-0.70) were associated with c-SDI >1. CONCLUSIONS: We conclude that the severity of VFs was associated with age, atherogenic factors and bone metabolism markers.

Metabolic syndrome after kidney transplantation.

Metabolic syndrome (MS) can be linked to the progression of chronic renal transplant dysfunction (CRTD). Hyperfiltration in transplanted patients is a further risk factor for MS and for the progression of CRTD. Many studies show in kidney-transplanted subjects a prevalence of MS at 60% after 6 years posttransplantation. We studied 182 patients (126 men and 56 women) with functioning renal transplant in Messina and Rovigo Renal Units. In our patients we saw at 6 years postkidney transplant in men a prevalence of MS at 20% (NCEPATPIII criteria) or 30% (Rovigo-Messina more strict criteria), and women at 6 years posttransplantation a prevalence of MS at 25% (NCEPATPIII criteria) or 50% (Rovigo-Messina criteria). In our patients, the period of graft function was over 15 years. This result is due to continued follow-up of metabolic parameters and to moderate protein (0.8-0.9 g/kg/day), low lipid, and low caloric intake. These strategies permit the avoidance of hyperfiltration, the reduction of hyperlipidemia and obesity. Special attention is due to women 50-65 years old. In these patients the prevalence of metabolic syndrome 6 years posttransplant is very high (60%). Postmenopausal syndrome is an additional risk factor for MS, atherosclerosis, and the progression of CRTD.

Factors affecting nutritional status, response to exercise, and progression of chronic rejection in kidney transplant recipients.

The nutritional status and the function of a renal graft are satisfactory in kidney transplantation patients who observe their dietary prescription. A reduction in maximal exercise test capacity in kidney transplant recipients are thought to be a consequence of uremic muscle dysfunction and also of changes in muscle structure associated with immunosuppressive therapy. Daily regular physical activity is recommended. Patients with a functioning renal transplant, as well as hemodialyzed patients, have an increased risk for development of cardiovascular diseases such as hypertension, hyperlipidemia, hyperglycemia, and obesity. The reduction of obesity and of cardiovascular risk factors in these patients are goals to be obtained by adequate nutrition, exercise, and physical activity.