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

Nefrologia. May-Jun 2016;36(3):255-67. doi: 10.1016/j.nefro.2016.03.004. Epub 2016 Apr 28.
[Article in En, Spanish]


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.

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.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Albuminuria / etiology
  • Aorta, Abdominal
  • Aortic Diseases / etiology
  • Aortic Diseases / metabolism*
  • Calcinosis / etiology
  • Calcinosis / metabolism*
  • Cross-Sectional Studies
  • Cyclosporine / adverse effects
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / etiology
  • Hyperparathyroidism, Secondary / metabolism
  • Immunosuppressive Agents / adverse effects
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Minerals / metabolism*
  • Parathyroid Hormone / blood
  • Postoperative Complications / metabolism*
  • Risk Factors
  • Sex Factors*
  • Spinal Fractures / etiology
  • Spinal Fractures / metabolism*
  • Tacrolimus / adverse effects
  • Vitamin D Deficiency / complications


  • Immunosuppressive Agents
  • Minerals
  • Parathyroid Hormone
  • Cyclosporine
  • Tacrolimus