Prevencija gubitka koštane mase pamidronatom nakon transplantacije bubrega

doctoral thesis

• Title (english): Efficacy of pamidronate in prevention of bone loss after renal transplantation
• Author: Tomislav Kuliš
• Mentor: Željko Kaštelan (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2013-04-26, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Uvod: Gubitak koštane mase kod bolesnika nakon transplantacije bubrega
predstavlja važan klinički problem budući da se na već postojeće oštećenje kosti
(posljedica kronične bubrežne bolesti), koštana masa dodatno gubi radi
imunosupresivne terapije. Gubitak koštane mase najviše je izražen u tijeku prve
godini nakon transplantacije bubrega.
Bisfosfonati su lijekovi koji smanjuju resorpciju kosti te su se pokazali
učinkovitima u liječenju mnogih bolesti, poput osteoporoze i multiplog mijeloma.
Dosadašnja istraživanja pokazala su dobar učinak bisfosfonata na prevenciju gubitka
kosti nakon transplantacije bubrega. Trenutno, ne postoji ujednačen stav o primjeni
navedene terapije, pa tako niti o optimalnoj dozi, trenutku započinjanja s terapijom te
trajanju terapije. Cilj ovog istraživanja je ispitati učinkovitost niskih doza pamidronata
u prevenciji gubitka koštane mase u prvoj godini nakon transplantacije bubrega. ----- Bolesnici i metode: U ispitivanju je sudjelovalo 36 bolesnika kojima je
transplantiran bubreg u KBC Zagreb. U ispitivanoj skupini koja je primala pamidronat
u dozi 0.5mg/kg u dva navrata, unutar mjesec dana od transplantacije bubrega te
mjesec dana nakon prve doze lijeka, uključeno je 19 bolesnika. U kontrolnoj skupini
uključeno je 17 bolesnika. Promjena koštane mase mjerena je DXA denzitometrijom
u tri navrata, neposredno nakon transplantacije bubrega, potom 6 i 12 mjeseci nakon
transplantacije. ----- Rezultati: Istraživanje je potvrdilo učinak pamidronata te je pokazalo
smanjenje gubitka koštane mase u ispitivanoj skupini u odnosu na kontrolnu.
Smanjenje gubitka koštane mase je statistički značajno na lumbalnoj kralježnici na
šest mjeseci te granično izraženo na Wardovom trokutu bedrene kosti isto na šest
mjeseci od transplantacije bubrega. U studiji nije zabilježen negativni učinak
primijenjenog lijeka na funkciju presatka. ----- Zaključak: Pamidronat smanjuje gubitak koštane mase u ranom periodu nakon
transplantacije bubrega. Moguće je preporučiti ovakvu shemu doziranja pamidronata
u svrhu prevencije gubitka koštane mase, a uz minimalni rizik od neželjenih učinaka.
Dodatna istraživanja su potrebna radi dobivanja odgovora na pitanje kod kojih
skupina bolesnika bi primjena lijeka bila medicinski i ekonomski opravdana.

Abstract (english)

Introduction: Bone loss in kidney transplant recipients presents an important
problem since it adds on already present uremic osteodistrophy. Additional bone loss
is mostly caused by immunosuppressive therapy (corticosterodis) which follows
transplantation. It has been shown that bone loss is most significant during the first
12 months after renal transplantation.
Bisphosphonates are drugs that reduce bone loss and are effective in
treatment of diseases that affect bone metabolism. There are some studies reporting
that bisphosphonates attenuate bone loss in kidney transplant recipients. However,
no consensus has been reached on dosage, initiation and duration of the treatment.
Aim of this study is to test the effectiveness of low dose pamidronate in bone
loss prevention during the first year after renal transplantation. ----- Patients and methods: In this study 35 patients were included after successful
renal transplantation in UHC Zagreb. Intervention group (n=19) received two doses of
0.5 mg/kg pamidronate, during first month after transplantation and three months
after the first dose. Control group consisted of 17 patients. Bone density was
measured by dual energy X-ray absorptiometry (DXA) during hospitalization for renal
transplantation, then six and twelve months after renal transplantation. ----- Results: This study confirmed protective effect of low doses pamidronate on
bone in the early period after renal transplantation. Pamidronate significantly reduced
bone loss on lumbar spine and at Ward's area of femur at six months after renal
transplantation. There were no negative effects of pamidronate on graft function. ----- Conclusion: Low dose pamidronate reduces bone loss in the early period after
renal transplantation. It is possible to recommend this application scheme for
prevention of bone loss. Further studies are needed to answer in which patients
application of bisphosphonates would be medically and economically justified.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:577372
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 95 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 07:08:10