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

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• 作者：Armando Torres^a ; ^{atorres@ull.es" class="auth_mail" title="E-mail the corresponding author} ; Vicens Torregrosa^b ; Roberto Marcen^c ; Josep Marí ; a Campistol^b ; Manuel Arias^d ; Domingo Herná ; ndez^e ; Constantino Ferná ; ndez^f ; Nuria Esforzado^b ; Raphael Paschoalin^b ; Nuria P&eacute ; rez^b ; Ana Isabel Garcí ; a^b ; Montserrat Del Amo^b ; Jaume Pom&eacute ; s^b ; Ana Gonzá ; lez Rinne^a ; Domingo Marrero^a ; Estefaní ; a P&eacute ; rez^a ; Fernando Henrí ; quez^g ; Juan Manuel Dí ; az^h ; Irene Silva^h ; Veró ; nica Ló ; pez^e ; Manuel Perelloⁱ ; David Ramos^j ; Isabel Beneyto^j ; Jos&eacute ; Marí ; a Cruzado^k ; Alberto Martí ; nez Castelao^k ; Juan Bravo^l ; Minerva Rodrí ; guez^m ; Carmen Dí ; az^m ; Josep Crespoⁿ ; Fernando Anaya^o ; Marí ; a Luisa Rodrí ; guez^o ; Juan Jos&eacute ; Cubero^p ; Pilar Pascual^q ; Rafael Romero^r ; Amado Andr&eacute ; s Belmonte^s ; Marí ; a Dolores Checa^t ; Carlos Jim&eacute ; nez^u ; Fernando Escuin^u ; Marta Crespo^v ; Marisa Mir^v ; Gonzalo Gó ; mez^w ; Beatriz Bayes^x ; Marí ; a Jos&eacute ; Gonzá ; lez^y ; Alex Guti&eacute ; rrez^z ; Marta Cuberes^z ; Alberto Rodrí ; guez Benoit^aa ; Teresa Garcí ; a^ab ; Francisco Llamas^ac ; Agustí ; n Ortega^ac ; Jos&eacute ; Luis Conde^ad
• 关键词：Kidney transplant ; Vitamin D deficiency ; Persistent hyperparathyroidism ; Vertebral fractures ; Vascular calcifications ; Cyclosporin A ; Tacrolimus
• 刊名：Nefrología (English Edition)
• 出版年：2016
• 出版时间：May-June 2016
• 年：2016
• 卷：36
• 期：3
• 页码：255-267
• 全文大小：329 K

文摘

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 <15 ng/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 100 pg/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.