Managing Bone Health After Kidney Transplant, with Abdul Ali Abdellatif, M.D.

Managing bone health in kidney transplant patients is a complex journey that begins long before the transplant itself — starting when patients are diagnosed with chronic kidney disease (CKD). As kidney function declines, hormonal changes occur, which can lead to bone and vascular damage.

In an interview with The Educated Patient, Abdul Ali Abdellatif, M.D., clinical assistant professor of medicine within the Division of Nephrology, Kidney Hypertension Transplant Clinic, at Baylor College of Medicine, emphasizes the importance of educating patients about maintaining bone health early, even before they reach end-stage renal disease or begin dialysis.

At this point, it's crucial for patients to manage their diet, specifically by limiting phosphorus, to maintain calcium and parathyroid hormone balance. These hormones, essential for bone health, can become harmful when kidneys are no longer functioning properly, contributing to bone damage and vascular issues.

Abdellatif says his goal is to perform preemptive kidney transplants — before patients require dialysis — to reverse the harmful processes caused by CKD. A successful transplant can restore hormone balance, protect bone health, and normalize calcium and phosphorus levels. However, some patients, even after a transplant, continue to have advanced disease that requires ongoing medication.

Abdellatif explains that studies have shown that patients often have preexisting bone damage by the time they receive a transplant, due to the prolonged impact of CKD. Additionally, post-transplant, some patients develop gout, which further exacerbates bone damage. Using advanced imaging like dual-energy CT (DECT) scans, clinicians can detect and measure uric acid deposits in the bones, even when they aren't visible during a physical exam. This technology allows doctors to track the effectiveness of treatments over time, seeing how deposits diminish with proper therapy.

Transplant patients often face compounded bone health challenges. Many are on steroids, which are part of standard care but can weaken bones. They already have bone issues from CKD, are at risk from gout, and now have additional risks from steroid use. These factors increase the likelihood of fractures, osteoporosis and even anemia. Abdellatif emphasizes that advanced imaging not only helps monitor treatment progress but also guides clinicians in determining when therapy is complete, ensuring that they address the unique and multiple risks faced by kidney transplant patients.