Armando Torres1, Vicens Torregrosa2, Roberto Marcen3, Josep María Campistol2, Manuel Arias4, Domingo Hernández5, Constantino Fernández6, Nuria Esforzado2, Raphael Paschoalin2, Nuria Pérez2, Ana Isabel García2, Montserrat Del Amo2, Jaume Pomés2, Ana González Rinne7, Domingo Marrero7, Estefanía Pérez7, Fernando Henríquez8, Juan Manuel Díaz9, Irene Silva9, Verónica López5, Manuel Perello10, David Ramos11, Isabel Beneyto11, José María Cruzado12, Alberto Martínez Castelao12, Juan Bravo13, Minerva Rodríguez14, Carmen Díaz14, Josep Crespo15, Fernando Anaya16, María Luisa Rodríguez16, Juan José Cubero17, Pilar Pascual18, Rafael Romero19, Amado Andrés Belmonte20, María Dolores Checa21, Carlos Jiménez22, Fernando Escuin22, Marta Crespo23, Marisa Mir23, Gonzalo Gómez24, Beatriz Bayes25, María José González26, Alex Gutiérrez27, Marta Cuberes27, Alberto Rodríguez Benoit28, Teresa García29, Francisco Llamas30, Agustín Ortega30, José Luis Conde31, Carlos Gómez Alamillo4. 1. Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain. Electronic address: atorres@ull.es. 2. Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain. 3. Servicio de Nefrología, Hospital Universitario Ramón y Cajal (RedInRen, RD12/0021/0020-Instituto de Salud Carlos III), Madrid, Spain. 4. Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, RedInRen RD12/0021/0007-Instituto de Salud Carlos III, Santander, Spain. 5. Servicio de Nefrología, Hospital Regional Carlos Haya, Universidad de Málaga (IBIMA), RedInRen RD12/0021/0015-Instituto de Salud Carlos III, Málaga, Spain. 6. Servicio de Nefrología, Complexo Hospitalario Universitario Juan Canalejo, A Coruña , Spain. 7. Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain. 8. Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain. 9. Servicio de Nefrología, Fundació Puigvert I.U.N.A, Barcelona, Spain. 10. Servicio de Nefrología, Hospital Vall D́Hebrón, Barcelona, Spain. 11. Servicio de Nefrología, Hospital Universitario La Fe, Valencia, Spain. 12. Servicio de Nefrología, Hospital Universitario de Bellvitge, Barcelona, Spain. 13. Servicio de Nefrología, Hospital Universitario Virgen de las Nieves, Granada, Spain. 14. Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain. 15. Servicio de Nefrología, Hospital Universitario Doctor Peset, Valencia, Spain. 16. Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 17. Servicio de Nefrología, Hospital Regional Universitario Infanta Cristina, Badajoz, Spain. 18. Servicio de Nefrología, Hospital Clínico Universitario de Valladolid, Spain. 19. Servicio de Nefrología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. 20. Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain. 21. Servicio de Nefrología, Centro Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain. 22. Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain. 23. Servicio de Nefrología, Hospital del Mar, Barcelona, Spain. 24. Servicio de Nefrología, Hospital Universitario Son Dureta, Palma de Mallorca, Spain. 25. Servicio de Nefrología, Hospital Universitario Germans Trias I Pujol, Barcelona, Spain. 26. Servicio de Nefrología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 27. Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain. 28. Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain. 29. Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain. 30. Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Spain. 31. Servicio de Nefrología, Hospital Complejo Hospitario de Toledo, Spain.
Abstract
BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: 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. RESULTS: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. CONCLUSIONS: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.