1,25-Dihydroxyvitamin D Deficiency Predicts Poorer Outcome After Renal Transplantation

Falkiewicz, K; Boratyńska, Maria; Speichert-Bidzińska, B.; Magott-Procelewska, Maria; Biecek, Przemysław; Patrzałek, D.; Klinger, Marian

doi:10.1016/j.transproceed.2009.07.087

Cited by 26 publications

(28 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This highly prevalent problem has been reported consistently among patients with end-stage lung disease 2,3 and in patients awaiting other solid-organ transplants. [27][28][29][30] Several factors may have contributed to 25(OH)D deficiency in our patients. Adipose and skeletal muscle tissues necessary for storage of vitamin D are commonly decreased in patients with chronic lung disease.…”

Section: Discussionmentioning

confidence: 86%

“…An association between 25(OH)D deficiency and organ rejection has also been reported in liver, kidney and heart transplant recipients. [27][28][29] Allograft rejection is initiated when antigen-presenting cells, such as dendritic cells, present T lymphocytes with foreign antigen from the allograft. This leads to recruitment and activation of effector T cells to the allograft, which consequently results in loss of function and allograft injury.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Low vitamin D levels are associated with increased rejection and infections after lung transplantation

Lowery

Bemiss

Cascino

et al. 2012

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Low vitamin D levels are associated with increased rejection and infections after lung transplantation

Lowery

Bemiss

Cascino

et al. 2012

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

“…In addition to the reduced sunlight exposure, the use of sun protectors, and the impaired kidney function, the use of immunosuppressive drugs especially high doses of steroid, and the presence of metabolic syndrome and obesity are also associated with 25OHD deficiency [26,28] ; Lower 25OHD level in KT recipients can worsen the degree of hyperparathyroidism by depleting the substrate for 1,25dihydroxyvitamin D (1,25OH2D) production [25] . Severe 1,25OH2D deficiency can be observed in up to 80% in the immediate posttransplant period [29] . The concentration of 1,25OH2D increases rapidly thereafter and becomes comparable to CKD patients with equivalent kidney function after 312 mo [5] .…”

Section: Vitamin Dmentioning

confidence: 99%

Mineral and bone disorder after kidney transplantation

Taweesedt

Disthabanchong

2015

WJT

View full text Add to dashboard Cite

After successful kidney transplantation, accumulated waste products and electrolytes are excreted and regulatory hormones return to normal levels. Despite the improvement in mineral metabolites and mineral regulating hormones after kidney transplantation, abnormal bone and mineral metabolism continues to present in most patients. During the first 3 mo, fibroblast growth factor-23 (FGF-23) and parathyroid hormone levels decrease rapidly in association with an increase in 1,25-dihydroxyvitamin D production. Renal phosphate excretion resumes and serum calcium, if elevated before, returns toward normal levels. FGF-23 excess during the first 3-12 mo results in exaggerated renal phosphate loss and hypophosphatemia occurs in some patients. After 1 year, FGF-23 and serum phosphate return to normal levels but persistent hyperparathyroidism remains in some patients. The progression of vascular calcification also attenuates. High dose corticosteroid and persistent hyperparathyroidism are the most important factors influencing abnormal bone and mineral metabolism in long-term kidney transplant (KT) recipients. Bone loss occurs at a highest rate during the first 6-12 mo after transplantation. Measurement of bone mineral density is recommended in patients with estimated glomerular filtration rate > 30 mL/min. The use of active vitamin D with or without bisphosphonate is effective in preventing early post-transplant bone loss. Steroid withdrawal regimen is also beneficial in preservation of bone mass in long-term. Calcimimetic is an alternative therapy to parathyroidectomy in KT recipients with persistent hyperparathyroidism. If parathyroidectomy is required, subtotal to near total parathyroidectomy is recommended. Performing parathyroidectomy during the waiting period prior to transplantation is also preferred in patients with severe hyperparathyroidism associated with hypercalcemia.

show abstract

“…In the face of vitamin D deficiency, hyperparathyroidism, skeletal abnormalities [1], cardiovascular comorbidities including hypertension and left ventricular hypertrophy [8] and even worsening graft function [9,10] may occur. Previous studies in children have examined the vitamin D status of renal transplant recipients and associations with surrogate biochemical end-points, but not described important patient level outcomes.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D deficiency is associated with short stature and may influence blood pressure control in paediatric renal transplant recipients

et al. 2011

View full text Add to dashboard Cite

Vitamin D deficiency is common in adult renal transplant recipients, but data in children are scarce. Vitamin D is shown to have multiple effects on the cardiovascular system, renal function, and maintenance of bone health. We hypothesized that 25(OH)D deficiency is common in pediatric renal transplant recipients, and may be associated with hyperparathyroidism, short stature, renal function, and blood pressure control. We recruited 106 children during the winter/spring season who had a functioning renal transplant for at least 3 months. Twenty-five hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were measured and correlated with clinical and biochemical parameters. Of the renal transplant patients, 38% were 25(OH)D deficient, 54% had insufficient levels, and only 8% had adequate 25(OH)D levels. Despite alfacalcidol supplementation in 59 (56%) patients, parathyroid hormone was increased in 58 (55%) and showed an inverse correlation with 25(OH)D (p = 0.0003, r = 0.61) but not with 1,25(OH)(2)D levels. Height standard deviation score (SDS) correlated with 25(OH)D (p = 0.007, r = 0.42) and time post transplantation (p = 0.02, r = 0.23); both were significant and independent predictors of height SDS. 25(OH)D inversely correlated with systolic BP SDS (p = 0.02, r =-0.26); this association was lost on multiple regression analysis, but 25(OH)D was the only modifiable risk factor for hypertension. There was no correlation with estimated GFR or proteinuria. In conclusion, 25(OH)D deficiency is common in pediatric renal transplant recipients and correlates with hyperparathyroidism and short stature. 25(OH)D deficiency may be a modifiable risk factor for hypertension in transplant recipients. Further studies are required to test if routine supplementation with ergo or cholecalciferol is safe and effective in children after renal transplantation.

show abstract

1,25-Dihydroxyvitamin D Deficiency Predicts Poorer Outcome After Renal Transplantation

Cited by 26 publications

References 12 publications

Low vitamin D levels are associated with increased rejection and infections after lung transplantation

Low vitamin D levels are associated with increased rejection and infections after lung transplantation

Mineral and bone disorder after kidney transplantation

Vitamin D deficiency is associated with short stature and may influence blood pressure control in paediatric renal transplant recipients

Contact Info

Product

Resources

About