title: Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).
abstract: OBJECTIVE
  The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established.
  
  
  METHODS
  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.
authors.affiliation: 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.
authors.forename: Armando
authors.initials: A
authors.lastname: Torres
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Vicens
authors.initials: V
authors.lastname: Torregrosa
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal (RedInRen, RD12/0021/0020-Instituto de Salud Carlos III), Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marcen
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Josep María
authors.initials: JM
authors.lastname: Campistol
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, RedInRen RD12/0021/0007-Instituto de Salud Carlos III, Santander, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
authors.affiliation: Servicio de Nefrología, Hospital Regional Carlos Haya, Universidad de Málaga (IBIMA), RedInRen RD12/0021/0015-Instituto de Salud Carlos III, Málaga, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernández
authors.affiliation: Servicio de Nefrología, Complexo Hospitalario Universitario Juan Canalejo, A Coruña , Spain.
authors.forename: Constantino
authors.initials: C
authors.lastname: Fernández
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Esforzado
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Raphael
authors.initials: R
authors.lastname: Paschoalin
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Pérez
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: García
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Del Amo
authors.affiliation: Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Pomés
authors.affiliation: Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: González Rinne
authors.affiliation: Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Marrero
authors.affiliation: Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Pérez
authors.affiliation: Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Henríquez
authors.affiliation: Servicio de Nefrología, Fundació Puigvert I.U.N.A, Barcelona, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Díaz
authors.affiliation: Servicio de Nefrología, Fundació Puigvert I.U.N.A, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Silva
authors.affiliation: Servicio de Nefrología, Hospital Regional Carlos Haya, Universidad de Málaga (IBIMA), RedInRen RD12/0021/0015-Instituto de Salud Carlos III, Málaga, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: López
authors.affiliation: Servicio de Nefrología, Hospital Vall D́Hebrón, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Perello
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Ramos
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Beneyto
authors.affiliation: Servicio de Nefrología, Hospital Universitario de Bellvitge, Barcelona, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Cruzado
authors.affiliation: Servicio de Nefrología, Hospital Universitario de Bellvitge, Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martínez Castelao
authors.affiliation: Servicio de Nefrología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Bravo
authors.affiliation: Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Minerva
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Díaz
authors.affiliation: Servicio de Nefrología, Hospital Universitario Doctor Peset, Valencia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Crespo
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Anaya
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Rodríguez
authors.affiliation: Servicio de Nefrología, Hospital Regional Universitario Infanta Cristina, Badajoz, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Cubero
authors.affiliation: Servicio de Nefrología, Hospital Clínico Universitario de Valladolid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Pascual
authors.affiliation: Servicio de Nefrología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero
authors.affiliation: Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Amado
authors.initials: A
authors.lastname: Andrés Belmonte
authors.affiliation: Servicio de Nefrología, Centro Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Checa
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jiménez
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Escuin
authors.affiliation: Servicio de Nefrología, Hospital del Mar, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Servicio de Nefrología, Hospital del Mar, Barcelona, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Mir
authors.affiliation: Servicio de Nefrología, Hospital Universitario Son Dureta, Palma de Mallorca, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Gómez
authors.affiliation: Servicio de Nefrología, Hospital Universitario Germans Trias I Pujol, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bayes
authors.affiliation: Servicio de Nefrología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: González
authors.affiliation: Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Cuberes
authors.affiliation: Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodríguez Benoit
authors.affiliation: Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: García
authors.affiliation: Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Llamas
authors.affiliation: Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Ortega
authors.affiliation: Servicio de Nefrología, Hospital Complejo Hospitario de Toledo, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Conde
authors.affiliation: Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, RedInRen RD12/0021/0007-Instituto de Salud Carlos III, Santander, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Gómez Alamillo
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000209:etiology / Q000378:metabolism*; D002114:Calcinosis / Q000209:etiology / Q000378:metabolism*; D003430:Cross-Sectional Studies; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000378:metabolism; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications / Q000378:metabolism*; D012307:Risk Factors; D012737:Sex Factors; D016103:Spinal Fractures / Q000209:etiology / Q000378:metabolism*; D016559:Tacrolimus / Q000009:adverse effects; D014808:Vitamin D Deficiency / Q000150:complications
chemical_list: D007166:Immunosuppressive Agents; D008903:Minerals; D010281:Parathyroid Hormone; D016572:Cyclosporine; D016559:Tacrolimus
keywords: Calcificaciones vasculares; Ciclosporina A; Cyclosporin A; Deficiencia de vitamina D; Fracturas vertebrales; Hiperparatiroidismo persistente; Kidney transplant; Persistent hyperparathyroidism; Tacrolimus; Trasplante renal; Vascular calcifications; Vertebral fractures; Vitamin D deficiency