Vascular calcification progression and its association with mineral and bone disorder in kidney transplant recipients

Ren Fail. 2023;45(2):2276382. doi: 10.1080/0886022X.2023.2276382. Epub 2023 Nov 7.

Abstract

Background: The assessment and prevention of vascular calcification (VC) in kidney transplant recipients (KTRs) have not been systematically studied. We aimed to evaluate VC change one year after kidney transplantation (KT) and identify their influencing factors.

Methods: 95 KTRs (68 males; ages 40.2 ± 10.8 years) were followed one year after KT. Changes in bone mineral density (BMD) and bone metabolism biomarkers were assessed. Coronary artery calcification (CAC) and thoracic aortic calcification (TAC) were measured using 192-slice third-generation dual-source CT. The relationship between bone metabolism indicators and VC and the factors influencing VC were analyzed.

Results: Postoperative estimated glomerular filtration rate was 79.96 ± 24.18 mL/min*1.73 m2. One year after KT, serum phosphorus, intact parathyroid hormone (iPTH), osteocalcin, type I collagen N-terminal peptide (NTx), type I collagen C-terminal peptide, and BMD decreased, 25-hydroxyvitamin D remained low, and VC increased. Post-CAC and TAC were negatively correlated with pre-femoral neck BMD, and TAC was positively correlated with post-calcium. CAC and TAC change were positively correlated with post-calcium and 25-hydroxyvitamin D. Increased CAC was positively associated with hemodialysis and pre-femoral neck osteopenia. CAC change was positively associated with prediabetes, post-calcium, and pre-CAC and negatively associated with preoperative and postoperative femoral neck BMD, and NTx change. Increased TAC was positively associated with age, prediabetes, preoperative parathyroid hyperplasia/nodule, post-calcium, and post-femoral neck osteopenia. TAC change was positively associated with age, diabetes, pre-triglyceride, pre-TAC, dialysis time, post-calcium and post-iPTH, and negatively associated with post-femoral neck BMD.

Conclusions: Mineral and bone disorders persisted, and VC progressed after KT, showing a close relationship.

Keywords: Kidney transplantation; coronary artery calcification; mineral and bone disorder; thoracic aortic calcification; vascular calcification.

MeSH terms

  • Bone Density
  • Bone Diseases, Metabolic*
  • Calcium
  • Collagen Type I
  • Humans
  • Kidney Transplantation* / adverse effects
  • Male
  • Minerals
  • Peptides
  • Prediabetic State*
  • Vascular Calcification* / diagnostic imaging
  • Vascular Calcification* / etiology
  • Vascular Calcification* / metabolism

Substances

  • Calcium
  • Collagen Type I
  • Minerals
  • Peptides

Grants and funding

This work was supported by the National Natural Science Foundation of China [grant numbers 82170769, 81870512, 82070769, 81770751, and 81900684].