D’Marco L, Bellasi A, Mazzaferro S, Raggi P. Vascular calcification, bone and mineral metabolism after kidney transplantation. World J Transplant 2015; 5(4): 222-230 [PMID: 26722649 DOI: 10.5500/wjt.v5.i4.222]
Corresponding Author of This Article
Paolo Raggi, MD, Mazankowski Alberta Heart Institute, Division of Cardiology, Department of Medicine, School of Medicine, University of Alberta, 8440-112 Street, Suite 4A7.050, Edmonton, AB T6G 2B7, Canada. raggi@ualberta.ca
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 24, 2015; 5(4): 222-230 Published online Dec 24, 2015. doi: 10.5500/wjt.v5.i4.222
Vascular calcification, bone and mineral metabolism after kidney transplantation
Luis D’Marco, Antonio Bellasi, Sandro Mazzaferro, Paolo Raggi
Luis D’Marco, Unidad Avanzada de Investigación y Diagnostico Ecográfico y Renal, Clínica Puerto Ordaz, Puerto Ordaz 8050, Venezuela
Antonio Bellasi, U.O.C. di Nefrologia, Dialisi, Ospedale Sant’Anna, Azienda Ospedaliera Sant’Anna, 22020 Como, Italy
Antonio Bellasi, Department of Health Sciences, University of Milan, 20010 Milan, Italy
Sandro Mazzaferro, Department of Cardiovascular, Respiratory, Nephrological, Geriatric, and Anesthesiological Sciences, “Sapienza” University, 00161 Rome, Italy
Paolo Raggi, Mazankowski Alberta Heart Institute, Division of Cardiology, Department of Medicine, School of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada
Author contributions: D’Marco L ran PubMed searches, wrote part of the initial draft and subsequent versions, added all references to the final version of the manuscript; Bellasi A shared responsibility with D’Marco L and ran PubMed search, wrote part of the initial draft and subsequent versions, he suggested the review design and created the table; Mazzaferro S contributed to writing the initial draft and final version of the manuscript and contributed extensively to the understanding and presentation of post-renal transplant bone disease; Raggi P conceived and designed the structure of the review, contributed to writing the initial draft and wrote several versions as well as the final version of the manuscript, reviewed and corrected the English language, and he is the overall grantor of the project.
Conflict-of-interest statement: There are no conflicts of interest to report for any of the authors related to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paolo Raggi, MD, Mazankowski Alberta Heart Institute, Division of Cardiology, Department of Medicine, School of Medicine, University of Alberta, 8440-112 Street, Suite 4A7.050, Edmonton, AB T6G 2B7, Canada. raggi@ualberta.ca
Telephone: +1-780-4074575 Fax: +1-780-4077834
Received: June 24, 2015 Peer-review started: June 26, 2015 First decision: August 16, 2015 Revised: September 1, 2015 Accepted: November 13, 2015 Article in press: November 17, 2015 Published online: December 24, 2015 Processing time: 181 Days and 19.9 Hours
Abstract
The development of end stage renal failure can be seen as a catastrophic health event and patients with this condition are considered at the highest risk of cardiovascular disease among any other patient groups and risk categories. Although kidney transplantation was hailed as an optimal solution to such devastating disease, many issues related to immune-suppressive drugs soon emerged and it became evident that cardiovascular disease would remain a vexing problem. Progression of chronic kidney disease is accompanied by profound alterations of mineral and bone metabolism that are believed to have an impact on the cardiovascular health of patients with advanced degrees of renal failure. Cardiovascular risk factors remain highly prevalent after kidney transplantation, some immune-suppression drugs worsen the risk profile of graft recipients and the alterations of mineral and bone metabolism seen in end stage renal failure are not completely resolved. Whether this complex situation promotes progression of vascular calcification, a hall-mark of advanced chronic kidney disease, and whether vascular calcifications contribute to the poor cardiovascular outcome of post-transplant patients is reviewed in this article.
Core tip: Despite partial restoration of glomerular function many bone and vascular abnormalities that develop during dialysis persist after kidney transplantation. Cardiovascular risk factors are also highly prevalent after kidney transplantation and some immune-suppressive drugs worsen the risk profile of graft recipients. As a result kidney transplant recipients continue to demonstrate a high cardiovascular risk in part due to the effect of vascular calcification.
