title: Abnormalities in biomarkers of mineral and bone metabolism in kidney donors.
abstract: Previous studies have suggested that kidney donors may have abnormalities of mineral and bone metabolism typically seen in chronic kidney disease. This may have important implications for the skeletal health of living kidney donors and for our understanding of the pathogenesis of long-term mineral and bone disorders in chronic kidney disease. In this prospective study, 182 of 203 kidney donors and 173 of 201 paired normal controls had markers of mineral and bone metabolism measured before and at 6 and 36 months after donation (ALTOLD Study). Donors had significantly higher serum concentrations of intact parathyroid hormone (24.6% and 19.5%) and fibroblast growth factor-23 (9.5% and 8.4%) at 6 and 36 months, respectively, as compared to healthy controls, and significantly reduced tubular phosphate reabsorption (-7.0% and -5.0%) and serum phosphate concentrations (-6.4% and -2.3%). Serum 1,25-dihydroxyvitamin D3 concentrations were significantly lower (-17.1% and -12.6%), while 25-hydroxyvitamin D (21.4% and 19.4%) concentrations were significantly higher in donors compared to controls. Moreover, significantly higher concentrations of the bone resorption markers, carboxyterminal cross-linking telopeptide of bone collagen (30.1% and 13.8%) and aminoterminal cross-linking telopeptide of bone collagen (14.2% and 13.0%), and the bone formation markers, osteocalcin (26.3% and 2.7%) and procollagen type I N-terminal propeptide (24.3% and 8.9%), were observed in donors. Thus, kidney donation alters serum markers of bone metabolism that could reflect impaired bone health. Additional long-term studies that include assessment of skeletal architecture and integrity are warranted in kidney donors.
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA. Electronic address: bkasiske@cdrg.org.
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: rkumar@mayo.edu.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Kimmel
authors.affiliation: Department of Medicine, Ohio State University, Columbus, Ohio, USA.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Pesavento
authors.affiliation: Department of Medicine, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Roberto S
authors.initials: RS
authors.lastname: Kalil
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kraus
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Rabb
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Posselt
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Anderson-Haag
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Steffes
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA; Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
authors.affiliation: Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA.
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ravinder J
authors.initials: RJ
authors.lastname: Singh
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, Maryland, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase; D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption / Q000097:blood*; D001842:Bone and Bones / Q000502:physiology; D002117:Calcitriol / Q000097:blood; D024042:Collagen Type I / Q000097:blood; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000097:blood; D009392:Nephrectomy / Q000009:adverse effects*; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood*; D010446:Peptide Fragments; D010455:Peptides / Q000097:blood; D010710:Phosphates / Q000097:blood / Q000378:metabolism; D011347:Procollagen; D011446:Prospective Studies; D065608:Renal Reabsorption / Q000502:physiology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; C000717427:FGF23 protein, human; D008903:Minerals; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D010455:Peptides; D010710:Phosphates; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; D015675:Osteocalcin; D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002117:Calcitriol
keywords: FGF23; hyperparathyroidism; mineral metabolism; parathyroid hormone