Dual-Energy CT Bone Findings in Kidney Transplant Recipients with Uncontrolled Gout

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Background: CKD pts are at risk for metabolic bone disease including osteopenia and deposition disease. Monosodium urate crystal (MSU) deposits in gout also cause bone erosions/joint damage. The PROTECT study examined pegloticase safety/efficacy in immunosuppressed kidney transplant recipients (KTRs) with uncontrolled gout; a subset underwent dual-energy CT (DECT). Here we report baseline bone-related findings. Methods: Pts (eGFR≥15,>1yr post-transplant) with baseline DECT were included. Standard protocols were used to acquire images (bilateral hands/wrists, feet/ankles, and/or knees); default post-processing for MSU detection. A central reader interpreted images (typical DECT artifacts removed) and calculated erosion scores (additive% of pre-specified bones [OMERACT RAMRIS scoring1]). Results: 18regions of 8pts included (all male, 52.3±11.2yrs, time since transplant:18.7±6.9yrs, eGFR:45.6±12.4; SU:10.4±2.1mg/dL, 5.3±4.6 flares/6mo). DECT showed multiple bone abnormalities in all pts, including erosions and osteopenia/osteomalacia (trabecular bone loss, cortical thinning, and/or bone resorption). Erosions were common in feet/ankles and hands/wrists (both 7/8[88%]) and most severe in feet/ankles (≥10% eroded: 3/8[38%], ≥40% eroded: 2/8[25%]) and were adjacent to MSU deposits, non-MSU mineralized matrix, and/or not adjacent to any deposits (Figure). Conclusion: These images provide new insight on bone/soft tissue abnormalities in KTRs with uncontrolled gout. Though not an intended PROTECT outcome, DECT showed overall poor bone health. Given additional erosive bone/joint damage MSU deposits can cause, findings suggest effective gout management as an opportunity to improve an aspect of bone health in KTRs with gout. Reference 1. Dalbeth N et al. Rheumatology 2011;50:410-6 Funding: Commercial Support - Horizon Therapeutics (now Amgen, Inc.)

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