Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study)

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study)

Nefrología, April 2016

27133898

Armando Torres, Vicens Torregrosa, Roberto Marcen, Josep María Campistol, Manuel Arias, Domingo Hernández, Constantino Fernández, Nuria Esforzado, Raphael Paschoalin, Nuria Pérez, Ana Isabel García, Montserrat Del Amo, Jaume Pomés, Ana González Rinne, Domingo Marrero, Estefanía Pérez, Fernando Henríquez, Juan Manuel Díaz, Irene Silva, Verónica López, Manuel Perello, David Ramos, Isabel Beneyto, José María Cruzado, Alberto Martínez Castelao, Juan Bravo, Minerva Rodríguez, Carmen Díaz, Josep Crespo, Fernando Anaya, María Luisa Rodríguez, Juan José Cubero, Pilar Pascual, Rafael Romero, Amado Andrés Belmonte, María Dolores Checa, Carlos Jiménez, Fernando Escuin, Marta Crespo, Marisa Mir, Gonzalo Gómez, Beatriz Bayes, María José González, Alex Gutiérrez, Marta Cuberes, Alberto Rodríguez Benoit, Teresa García, Francisco Llamas, Agustín Ortega, José Luis Conde, Carlos Gómez Alamillo

The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.