DINH DƯỠNG PHÒNG NGỪA LOÃNG XƯƠNG CHO NGƯỜI BỆNH SAU GHÉP THẬN
Nội dung chính của bài viết
Tóm tắt
Loãng xương là vấn đề bệnh lý thường gặp ở người bệnh sau ghép thận do nhiều nguyên nhân khác nhau. Tình trạng này diễn biến âm thầm trong một thời gian kéo dài, có thể dẫn đến các hậu quả lớn về gãy xương, làm giảm chất lượng cuộc sống và làm trầm trọng hơn tình trạng bệnh lý. Chính vì vậy, việc bắt đầu theo dõi, dự phòng và điều trị cho các bệnh lý này từ sớm là vô cùng quan trọng. Trong đó dinh dưỡng là một biện pháp hỗ trợ an toàn, cần thiết cho người bệnh. Tuy nhiên đây cũng là vấn đề mới, chưa có khuyến nghị thống nhất cho người bệnh sau ghép thận. Trong bài viết này chúng tôi tổng hợp tất cả các vấn đề về bổ sung dinh dưỡng liên quan đến loãng xương, nhằm mục đích hỗ trợ lựa chọn, cân nhắc các biện pháp dinh dưỡng phù hợp, đầy đủ nhất để giúp người bệnh sau ghép thận ít bị ảnh hưởng nhất có thể bởi các bệnh lý về xương.
Từ khóa
loãng xương, ghép thận
Chi tiết bài viết
Tài liệu tham khảo
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3. Park WY, Han S, Choi BS, et al. Progression of Osteoporosis After Kidney Transplantation in Patients With End-Stage Renal Disease. Transplant Proc. 2017;49(5):1033-1037. doi:10.1016/j.transproceed.2017.03.038
4. Kim KJ, Ha J, Kim SW, et al. Bone Loss after Solid Organ Transplantation: A Review of Organ-Specific Considerations. Endocrinol Metab (Seoul). 2024;39(2):267-282. doi:10.3803/EnM.2024.1939
5. Alshayeb HM, Josephson MA, Sprague SM. CKD–Mineral and Bone Disorder Management in Kidney Transplant Recipients. American Journal of Kidney Diseases. 2013;61(2):310-325. doi:10.1053/j.ajkd.2012.07.022
6. Kurnool S, Shah N, Ekanayake P. Treatment of osteoporosis in the solid organ transplant recipient: an organ-based approach. Ther Adv Endocrinol Metab. 2025;16:20420188251347351. doi:10.1177/20420188251347351
7. Bộ Y tế. Cổng thông tin. Bệnh suy thận ngày càng gia tăng và trẻ hóa. Truy cập ngày 3/8/ 2025. tại https://moh.gov.vn/home?p_p_id=101&p_p_lifecycle=0&p_p_state=maximized&p_p_mode=view&_101_struts_action=%2Fasset_publisher%2Fview_content&_101_type=content&_101_urlTitle=benh-suy-than-ngay-cang-gia-tang-va-tre-hoa
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10. Teh JW, Mac Gearailt C, Lappin DWP. Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management. International Journal of Molecular Sciences. 2024;25(3):1859. doi:10.3390/ijms25031859
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12. Bệnh xương sau ghép | Quỹ Thận Quốc gia. Accessed August 12, 2025. https://www.kidney.org/post-transplant-bone-disease
13. Molnar MZ, Naser MS, Rhee CM, Kalantar-Zadeh K, Bunnapradist S. Bone and mineral disorders after kidney transplantation: therapeutic strategies. Transplant Rev (Orlando). 2014;28(2):56-62. doi:10.1016/j.trre.2013.12.003
14. Sánchez-Borrego R, Schacky C von, Osorio MJA, et al. Recommendations of the Spanish Menopause Society on the consumption of omega-3 polyunsaturated fatty acids by postmenopausal women. Maturitas. 2017;103:71-77. doi:10.1016/j.maturitas.2017.06.028
15. Botelho J, Machado V, Proença L, Delgado AS, Mendes JJ. Vitamin D Deficiency and Oral Health: A Comprehensive Review. Nutrients. 2020;12(5):1471. doi:10.3390/nu12051471.
16. Yu RW, Faull RJ, Coates PTH, Coates PS. Calcium supplements lower bone resorption after renal transplant. Clinical Transplantation. 2012;26(2):292-299. doi:10.1111/j.1399-0012.2011.01487.x
17. Karpouzos A, Diamantis E, Farmaki P, Savvanis S, Troupis T. Nutritional Aspects of Bone Health and Fracture Healing. J Osteoporos. 2017;2017:4218472. doi:10.1155/2017/4218472
18. Price CT, Langford JR, Liporace FA. Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet. Open Orthop J. 2012;6:143-149. doi:10.2174/1874325001206010143.
19. Sunyecz J. The use of calcium and vitamin D in the management of osteoporosis. TCRM. 2008;4(4):827-836. doi:10.2147/TCRM.S3552
20. Heaney RP. Calcium intake and disease prevention. Arq Bras Endocrinol Metabol. 2006;50(4):685-693. doi:10.1590/s0004-27302006000400014
21. Benaboud S, Urien S, Thervet E, et al. Determination of optimal cholecalciferol treatment in renal transplant recipients using a population pharmacokinetic approach. Eur J Clin Pharmacol. 2013;69(3):499-506. doi:10.1007/s00228-012-1378-3
22. Courbebaisse M, Thervet E, Souberbielle JC, et al. Effects of vitamin D supplementation on the calcium–phosphate balance in renal transplant patients. Kidney International. 2009;75(6):646-651. doi:10.1038/ki.2008.549
23. Wissing KM, Broeders N, Moreno-Reyes R, Gervy C, Stallenberg B, Abramowicz D. A Controlled Study of Vitamin D3 to Prevent Bone Loss in Renal-Transplant Patients Receiving Low Doses of Steroids. Transplantation. 2005;79(1):108. doi:10.1097/01.TP.0000149322.70295.A5
24. Bhoi S, Pal A, Das A. Effect of Calcium and Vitamin D on Bone Health among Kidney Transplant Recipients in a Prospective Randomized Controlled Trial. Indian Journal of Transplantation. 2024;18(3):282. doi:10.4103/ijot.ijot_141_23
25. Heaney RP. Vitamin D and calcium interactions: functional outcomes. Am J Clin Nutr. 2008;88(2):541S-544S. doi: 10.1093/ajcn/88.2.541S.
26. Chevarria J, Sexton DJ, Murray SL, et al. Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival. Clin Kidney J. 2020;14(4):1106-1113. doi:10.1093/ckj/sfaa061
27. Alanna JM, Arminda FK, Jonhon CC, US. Department of Agriculture. Phosphorus Intake of Americans, WWEIA, NHNAES 2011-12. Accessed July 31, 2025. https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/15_Phosphorus_intake_1112.pdf
28. Ahn CB, Je JY. Bone health-promoting bioactive peptides. Journal of Food Biochemistry. 2019;43(1):e12529. doi:10.1111/jfbc.12529
29. Sun S, Liu F, Liu G, et al. Effects of casein phosphopeptides on calcium absorption and metabolism bioactivity in vitro and in vivo. Food Funct. 2018;9(10):5220-5229. doi:10.1039/C8FO00401C
30. Cardoso DF, Marques EA, Leal DV, et al. Impact of physical activity and exercise on bone health in patients with chronic kidney disease: a systematic review of observational and experimental studies. BMC Nephrol. 2020;21:334. doi:10.1186/s12882-020-01999-z
31. Eatemadololama A, Karimi MT, Rahnama N, Rasolzadegan MH. Resistance exercise training restores bone mineral density in renal transplant recipients. Clin Cases Miner Bone Metab. 2017;14(2):157-160. doi:10.11138/ccmbm/2017.14.1.157
32. Roseanne E. Billany, Nicolette C. Bishop, Ellen M. Castle, Matthew P. M. Graham-Brown, Sharlene A. Greenwood, Courtney J. Lightfoot & Thomas J. Wilkinson. (2025) Physical activity interventions in adult kidney transplant recipients: an updated systematic review and meta-analysis of randomized controlled trials. Renal Failure 47:1. doi: 10.1080/10833196.2021.2002641
33. Stylemans D, Vandecruys M, Leunis S, Engelborghs S, Gargioli D, Monbaliu D, Cornelissen V, Van Craenenbroeck AH and De Smet S (2024) Physical Exercise After Solid Organ Transplantation: A Cautionary Tale. Transpl Int 37:12448. doi: 10.3389/ti.2024.12448
2. Lewiecki EM. Osteoporosis: Clinical Evaluation. In: Feingold KR, Ahmed SF, Anawalt B, et al., eds. Endotext. MDText.com, Inc.; 2000. Accessed August 12, 2025. http://www.ncbi.nlm.nih.gov/books/NBK279049/
3. Park WY, Han S, Choi BS, et al. Progression of Osteoporosis After Kidney Transplantation in Patients With End-Stage Renal Disease. Transplant Proc. 2017;49(5):1033-1037. doi:10.1016/j.transproceed.2017.03.038
4. Kim KJ, Ha J, Kim SW, et al. Bone Loss after Solid Organ Transplantation: A Review of Organ-Specific Considerations. Endocrinol Metab (Seoul). 2024;39(2):267-282. doi:10.3803/EnM.2024.1939
5. Alshayeb HM, Josephson MA, Sprague SM. CKD–Mineral and Bone Disorder Management in Kidney Transplant Recipients. American Journal of Kidney Diseases. 2013;61(2):310-325. doi:10.1053/j.ajkd.2012.07.022
6. Kurnool S, Shah N, Ekanayake P. Treatment of osteoporosis in the solid organ transplant recipient: an organ-based approach. Ther Adv Endocrinol Metab. 2025;16:20420188251347351. doi:10.1177/20420188251347351
7. Bộ Y tế. Cổng thông tin. Bệnh suy thận ngày càng gia tăng và trẻ hóa. Truy cập ngày 3/8/ 2025. tại https://moh.gov.vn/home?p_p_id=101&p_p_lifecycle=0&p_p_state=maximized&p_p_mode=view&_101_struts_action=%2Fasset_publisher%2Fview_content&_101_type=content&_101_urlTitle=benh-suy-than-ngay-cang-gia-tang-va-tre-hoa
8. NHS Blood and Transplant. Benefits and risks of a kidney transplant. Organ transplantation. Accessed August 3, 2025. https://www.nhsbt.nhs.uk/organ-transplantation/kidney/benefits-and-risks-of-a-kidney-transplant/
9. Atkinson SA, Ward WE. Clinical nutrition: 2. The role of nutrition in the prevention and treatment of adult osteoporosis. CMAJ. 2001;165(11):1511-1514.
10. Teh JW, Mac Gearailt C, Lappin DWP. Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management. International Journal of Molecular Sciences. 2024;25(3):1859. doi:10.3390/ijms25031859
11. Zhang R, Chouhan KK. Metabolic bone diseases in kidney transplant recipients. World J Nephrol. 2012;1(5):127-133. doi:10.5527/wjn.v1.i5.127
12. Bệnh xương sau ghép | Quỹ Thận Quốc gia. Accessed August 12, 2025. https://www.kidney.org/post-transplant-bone-disease
13. Molnar MZ, Naser MS, Rhee CM, Kalantar-Zadeh K, Bunnapradist S. Bone and mineral disorders after kidney transplantation: therapeutic strategies. Transplant Rev (Orlando). 2014;28(2):56-62. doi:10.1016/j.trre.2013.12.003
14. Sánchez-Borrego R, Schacky C von, Osorio MJA, et al. Recommendations of the Spanish Menopause Society on the consumption of omega-3 polyunsaturated fatty acids by postmenopausal women. Maturitas. 2017;103:71-77. doi:10.1016/j.maturitas.2017.06.028
15. Botelho J, Machado V, Proença L, Delgado AS, Mendes JJ. Vitamin D Deficiency and Oral Health: A Comprehensive Review. Nutrients. 2020;12(5):1471. doi:10.3390/nu12051471.
16. Yu RW, Faull RJ, Coates PTH, Coates PS. Calcium supplements lower bone resorption after renal transplant. Clinical Transplantation. 2012;26(2):292-299. doi:10.1111/j.1399-0012.2011.01487.x
17. Karpouzos A, Diamantis E, Farmaki P, Savvanis S, Troupis T. Nutritional Aspects of Bone Health and Fracture Healing. J Osteoporos. 2017;2017:4218472. doi:10.1155/2017/4218472
18. Price CT, Langford JR, Liporace FA. Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet. Open Orthop J. 2012;6:143-149. doi:10.2174/1874325001206010143.
19. Sunyecz J. The use of calcium and vitamin D in the management of osteoporosis. TCRM. 2008;4(4):827-836. doi:10.2147/TCRM.S3552
20. Heaney RP. Calcium intake and disease prevention. Arq Bras Endocrinol Metabol. 2006;50(4):685-693. doi:10.1590/s0004-27302006000400014
21. Benaboud S, Urien S, Thervet E, et al. Determination of optimal cholecalciferol treatment in renal transplant recipients using a population pharmacokinetic approach. Eur J Clin Pharmacol. 2013;69(3):499-506. doi:10.1007/s00228-012-1378-3
22. Courbebaisse M, Thervet E, Souberbielle JC, et al. Effects of vitamin D supplementation on the calcium–phosphate balance in renal transplant patients. Kidney International. 2009;75(6):646-651. doi:10.1038/ki.2008.549
23. Wissing KM, Broeders N, Moreno-Reyes R, Gervy C, Stallenberg B, Abramowicz D. A Controlled Study of Vitamin D3 to Prevent Bone Loss in Renal-Transplant Patients Receiving Low Doses of Steroids. Transplantation. 2005;79(1):108. doi:10.1097/01.TP.0000149322.70295.A5
24. Bhoi S, Pal A, Das A. Effect of Calcium and Vitamin D on Bone Health among Kidney Transplant Recipients in a Prospective Randomized Controlled Trial. Indian Journal of Transplantation. 2024;18(3):282. doi:10.4103/ijot.ijot_141_23
25. Heaney RP. Vitamin D and calcium interactions: functional outcomes. Am J Clin Nutr. 2008;88(2):541S-544S. doi: 10.1093/ajcn/88.2.541S.
26. Chevarria J, Sexton DJ, Murray SL, et al. Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival. Clin Kidney J. 2020;14(4):1106-1113. doi:10.1093/ckj/sfaa061
27. Alanna JM, Arminda FK, Jonhon CC, US. Department of Agriculture. Phosphorus Intake of Americans, WWEIA, NHNAES 2011-12. Accessed July 31, 2025. https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/15_Phosphorus_intake_1112.pdf
28. Ahn CB, Je JY. Bone health-promoting bioactive peptides. Journal of Food Biochemistry. 2019;43(1):e12529. doi:10.1111/jfbc.12529
29. Sun S, Liu F, Liu G, et al. Effects of casein phosphopeptides on calcium absorption and metabolism bioactivity in vitro and in vivo. Food Funct. 2018;9(10):5220-5229. doi:10.1039/C8FO00401C
30. Cardoso DF, Marques EA, Leal DV, et al. Impact of physical activity and exercise on bone health in patients with chronic kidney disease: a systematic review of observational and experimental studies. BMC Nephrol. 2020;21:334. doi:10.1186/s12882-020-01999-z
31. Eatemadololama A, Karimi MT, Rahnama N, Rasolzadegan MH. Resistance exercise training restores bone mineral density in renal transplant recipients. Clin Cases Miner Bone Metab. 2017;14(2):157-160. doi:10.11138/ccmbm/2017.14.1.157
32. Roseanne E. Billany, Nicolette C. Bishop, Ellen M. Castle, Matthew P. M. Graham-Brown, Sharlene A. Greenwood, Courtney J. Lightfoot & Thomas J. Wilkinson. (2025) Physical activity interventions in adult kidney transplant recipients: an updated systematic review and meta-analysis of randomized controlled trials. Renal Failure 47:1. doi: 10.1080/10833196.2021.2002641
33. Stylemans D, Vandecruys M, Leunis S, Engelborghs S, Gargioli D, Monbaliu D, Cornelissen V, Van Craenenbroeck AH and De Smet S (2024) Physical Exercise After Solid Organ Transplantation: A Cautionary Tale. Transpl Int 37:12448. doi: 10.3389/ti.2024.12448