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Updated: Apr 13, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Mineral and bone disorders in kidney transplant recipients: reversible, irreversible, and de novo abnormalities
Takashi Hirukawa1, Takatoshi Kakuta, Michio Nakamura
1Division of Nephrology, Endocrinology and Metabolism, Department of Medicine, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, Kanagawa, 259-1193, Japan.
Insights
Kidney transplant recipients face high mortality from cardiovascular events, often linked to chronic kidney disease-mineral and bone disorders (CKD-MBD). Improved CKD-MBD management before and after transplantation is crucial for better outcomes.
Area of Science:
- Nephrology
- Transplantation Medicine
- Cardiovascular Health
Background:
- Kidney transplantation significantly improves graft survival and quality of life.
- Despite advances, post-transplant mortality remains elevated, primarily due to cardiovascular events.
- Chronic kidney disease-mineral and bone disorders (CKD-MBD) are increasingly recognized as major contributors to poor prognosis in kidney transplant recipients.
Purpose of the Study:
- To highlight the persistent challenges of CKD-MBD post-kidney transplantation.
- To emphasize the need for comprehensive CKD-MBD management throughout the patient journey.
- To underscore the link between CKD-MBD and cardiovascular complications in this population.
Main Methods:
- Review of current literature on CKD-MBD in kidney transplant recipients.
- Analysis of serum mineral and bone parameters (phosphorus, calcium, vitamin D, PTH, FGF23).
- Evaluation of the impact of pre-transplant dialysis on post-transplant MBD abnormalities.
Main Results:
- While kidney function recovery normalizes some MBD parameters, irreversible abnormalities persist post-transplantation.
- Long-term dialysis can lead to persistent or progressive MBD issues.
- These persistent MBD abnormalities contribute to cardiovascular events and mortality.
Conclusions:
- CKD-MBD remains a significant challenge after kidney transplantation, impacting patient survival.
- Effective management of MBD is essential during pre-dialysis, dialysis, and post-transplant phases.
- Further research and clinical strategies are needed to address irreversible MBD post-transplantation to reduce cardiovascular risk.
Abstract:
Given the advances in medical technologies related to kidney transplantation, the post-transplant graft survival rate and quality of life have improved dramatically. Nevertheless, post-transplant mortality rate still remains high as compared to the general population due to the development of cardiovascular events. It has recently been widely recognized that chronic kidney disease-mineral and bone disorders (CKD-MBD) significantly contribute to such poor prognosis at least in part. In the majority of kidney recipients, abnormal serum parameters for mineral and bone disorder (MBD), such as phosphorus, calcium, 1,25-dihydroxyvitamin D, parathyroid hormone and fibroblast growth factor 23, gradually return toward acceptable levels following the re-establishment of kidney function after transplantation; however, some irreversible abnormalities, developed as the result of long-term dialysis, persist, require treatment, or even progress after kidney transplantation. Thus, better management of CKD-MBD during pre-dialysis and dialysis period as well as after kidney transplantation is highly appreciated.
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