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Limited knowledge exists on cardiorespiratory fitness (CR fitness) in adults having a renal transplant (Rtx) during childhood. Our aim was to assess CR fitness (V0) with a maximal treadmill test in former Rtx children reaching adulthood (ped-tx, n = 31), compared to patients Rtx as adults (adult-tx, n = 17) and healthy controls (HC, n = 36). Median age was 26.9 (19-41), 28.6 (23.5-34) and 33.5 (20-42) years, respectively. Median time since first Rtx was 18.1 (7-29) and 3.7 (1.2-12.6) years. Body composition was measured by dual-energy X-ray absorptiometry (DXA). V0 was median 37.9 (12.5-56.3), 40.8 (26.5-57.5), and 44.4 (29.5-65.6) ml kg min in the ped-tx, adult-tx, and HC, respectively. Ped-tx had significantly lower V0 compared to HC ( p = 0.01). Adult-tx had higher exercise capacity (test duration) compared to ped-tx (median 10.5 (7.5-16) and 9 (6-14) min, respectively ( p = 0.016). In multiple linear regression analysis, test duration, fat-free mass (FFM, kg) and Hgb (g/dl) were significant predictors of V0 explaining 86% of its variance. There was no significant difference between ped-tx and adult-tx in V0 CR fitness depicts long-term health outcome in Rtx patients both in regard to physical functioning and is a plausible indirect marker of CV health. [ABSTRACT FROM AUTHOR]

Background . Serum osteocalcin and C-terminal telopeptides of type-1 collagen (CTX-1) are known markers of bone turnover, whereas the role of fibroblast growth factor 23 (FGF-23) is yet unknown. We investigated early changes in bone mass and the association of these biochemical markers and FGF-23 with bone loss following renal transplantation (RTx). Material and methods. In 44 first-kidney allograft patients, BMD was measured by dual-energy X-ray absorptiometry in the lumbar spine (LS), total femur (TF) and total body (TB) at baseline and 10 weeks post-transplant. Serum osteocalcin, CTX-1, intact FGF-23, intact parathormone (iPTH) and 25-hydroxyvitamin D (25-OHD) levels were measured. Associations were tested by correlation and multiple linear regression. Results . We found a significant (p<0.05) decrease in bone mass in LS (2.6 %), TF (2.1 %) and TB (1.4 %). Osteocalcin (0.95 versus 1.56 nmol/L) and CTX-1 (1.05 versus 1.47 ng/mL) levels increased significantly, while serum FGF-23 and iPTH decreased. Serum osteocalcin and CTX-1 were significantly associated at both baseline and follow-up. Baseline osteocalcin and CTX-1 were independently associated with bone loss in TB and TF, respectively. Neither iPTH nor 25-OHD showed consistent association with bone loss. FGF-23 was not related to change in bone mass or to biochemical markers of bone turnover. Conclusion . Our results confirm an early decrease in bone mass with high bone resorption rate after RTx. Osteocalcin and CTX-1 are associated with bone loss in the early post-transplant period; thus, these markers may be a reasonable choice for routine assessment of bone turnover in this setting. The role of FGF-23 remains to be further elucidated. [ABSTRACT FROM AUTHOR]

Objective. Changes in body composition after renal transplantation (RTx) are of clinical significance, since increments in fat mass may contribute to glucose intolerance and cardiovascular morbidity. The aim of this study was to quantify the early changes in body composition after transplantation and identify predictors of these changes. Material and methods. Total and regional body composition of 102 first kidney allograft recipients were measured at transplantation and after 10 weeks using dual-energy X-ray absorptiometry. The population comprised a high proportion of pre-emptive and well-nourished kidney recipients. Multiple linear regression was used to identify predictors of change. Results. Mean fat mass was 27.1±8.7% of body weight at baseline. The fat mass percentage increased by 2.2% corresponding to a 1.3 kg increase in fat mass at 10 weeks (p< 0.001). Fat-free mass declined by 2.5 kg (p<0.001), with no significant loss of body weight (0.9 kg, p=0.11). Age, low-tertile fat mass, plasma C-reactive protein, time on dialysis and cumulative prednisolone dose were independent predictors (p<0.05) of the increase in fat mass. Cumulative prednisolone dose was the only significant predictor of decrease in fat-free mass. Essentially the same results were found for both genders. Conclusions. A significant increase in fat mass occurred rapidly after RTx along with a reduction in fat-free mass despite stable body weight. Early fat mass accumulation may predispose to comorbidity, but the long-term clinical significance of these early changes remains to be explored in prospective studies. [ABSTRACT FROM AUTHOR]

Patients with chronic renal failure (CRF) are at high risk of renal osteodystrophy. Our study aimed to identify predictors of bone mass and cumulative fracture rate at the time of renal transplantation (RTx). This is important since the patients experience further substantial bone loss the first month post-transplant. Material and methods: Altogether 133 renal transplant patients were examined for bone mineral density (BMD) using dual-energy X-ray absorptiometry shortly after RTx. Results: The patients’ Z-scores were significantly lower at the time of RTx compared to the reference population (p < 0.05), 32% were osteopenic and 11% had osteoporosis. Independent predictors of low bone mass were age (p < 0.001), female sex (p < 0.001), intact parathyroid hormone (iPTH) level (p < 0.001), former transplantation (p = 0.001) and time on hemodialysis (HD) (p = 0.005). Body mass index (BMI) (p < 0.001) and physical activity (p = 0.027) were associated with high BMD. Cumulative fracture rate (29%) was associated with physical inactivity (p = 0.003), BMI (p = 0.036) and osteopenia (p < 0.001) at the time of RTx. Conclusion: In a representative CRF population, BMD was reduced. Independent predictors of BMD were as for the general population, and uremia associated predictors were time on HD, previous transplantation and serum iPTH level. Fracture rate was high, and physical inactivity had the strongest association with fractures. [ABSTRACT FROM AUTHOR]