Are low levels of 25-hydroxyvitamin D a risk factor for cardiovascular diseases or malignancies in renal transplantation?

Marcén, R.; Jiménez, Sara; Fernández-Rodríguez, Ana; Galeano, C.; Villafruela, J.J.; Gomis, Antonio Giner; Teruel, J.L.; Quereda, C.

doi:10.1093/ndt/gfs508

Cited by 25 publications

(22 citation statements)

References 25 publications

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“…Although low vitamin D levels were not associated with a 3-year increased risk of CVD [61] , more recent data from stable KTRs showed an independent association between 25(OH)D levels <12 ng/ml and all-cause mortality [21] . Flow-mediated dilation consensually proved to increase 25(OH)D levels close to restored renal function and reduced FGF23 levels [62] .…”

Section: Vitamin D and Main Outcomes In Ktrs: Observational Datamentioning

confidence: 90%

Vitamin D in Kidney Transplant Recipients: Mechanisms and Therapy

Cianciolo¹,

Galassi

Capelli³

et al. 2016

Am J Nephrol

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Chronic kidney disease-mineral and bone disorder (CKD-MBD) is common in kidney transplant recipients (KTRs), where secondary hyperparathyroidism (HPTH) and post-transplantation bone disease (PTBD) are potential effectors of both graft and vascular aging. Reduced 25(OH)D levels are highly prevalent in KTRs. Experimental and clinical evidence support the direct involvement of deranged vitamin D metabolism in CKD-MBD among KTRs. This review analyzes the pathophysiology of vitamin D derangement in KTRs and its fall out on patient and graft outcome, highlighting the roles of both nutritional and active vitamin D compounds to treat PTBD, cardiovascular disease (CVD) and graft dysfunction. Fibroblast growth factor-23-parathyroid hormone (PTH)-vitamin D axis, immunosuppressive therapy and previous bone status have been associated with PTBD. Although several studies reported reduced PTH levels in KTRs receiving nutritional vitamin D, its effects on bone mineral density (BMD) remain controversial. Active vitamin D reduced PTH levels and increased BMD after transplantation, but paricalcitol treatment was not accompanied by benefits on osteopenia. Vitamin D is considered protective against CVD due to the widespread pleiotropic effects, but data among KTRs remain scanty. Although vitamin deficiency is associated with lower glomerular filtration rate (GFR) and faster estimated GFR decline and data on the anti-proteinuric effects of vitamin D receptor activation (VDRA) in KTRs sound encouraging, reports on related improvement on graft survival are still lacking. Clinical data support the efficacy of VDRA against HPTH and show promising evidence of VDRA's effect in counteracting post-transplant proteinuria. New insights are mandatory to establish if the improvement of surrogate outcomes will translate into better patient and graft outcome.

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Section: Vitamin D and Main Outcomes In Ktrs: Observational Datamentioning

confidence: 90%

Vitamin D in Kidney Transplant Recipients: Mechanisms and Therapy

Cianciolo¹,

Galassi

Capelli³

et al. 2016

Am J Nephrol

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“…Low 25OHD level can predict allcause mortality but not cardiovascular mortality in longterm KT recipients. This observation suggests that conditions other than cardiovascular disease, such as malignancy, may be the cause of an increased mortality [21,68] . Low 25OHD concentration measured 3 mo after transplantation is also an independent risk factor for interstitial fibrosis progression and is associated with lower GFR 1 year after transplantation [69] .…”

Section: Discussionmentioning

confidence: 99%

Mineral and bone disorder after kidney transplantation

Taweesedt

Disthabanchong

2015

WJT

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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.

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“…In Table 1 we have summarized the main results of those studies which reported on the prevalence of the native vitamin D status in different cohorts of KTx patients [32,33,34,35,36,37,38,39,40,41,42,43,44,45]. …”

Section: Epidemiology Of the Vitamin D Status In Ktx Recipientsmentioning

confidence: 99%

“…On the other hand, recent evidence, based on randomized clinical trials and metanalysis, has mitigated the enthusiasm about most of these alleged “pleiotropic” effects of vitamin D, since no clear beneficial effects of vitamin D supplementation has been demonstrated on the prevention of neoplasia, CV and/or metabolic complications in many clinical settings [39,66,67,68,69,70,71]. …”

Section: Vitamin D Status and Potential Non-mbm Related Effects Inmentioning

confidence: 99%

Nutritional Vitamin D in Renal Transplant Patients: Speculations and Reality

2017

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Reduced levels of nutritional vitamin D are commonly observed in most chronic kidney disease (CKD) patients and particularly in patients who have received a kidney transplant (KTx). In the complex clinical scenario characterizing the recipients of a renal graft, nutritional vitamin D deficiency has been put in relation not only to the changes of mineral and bone metabolism (MBM) after KTx, but also to most of the medical complications which burden KTx patients. In fact, referring to its alleged pleiotropic (non-MBM related) activities, vitamin D has been claimed to play some role in the occurrence of cardiovascular, metabolic, immunologic, neoplastic and infectious complications commonly observed in KTx recipients. Furthermore, low nutritional vitamin D levels have also been connected with graft dysfunction occurrence and progression. In this review, we will discuss the purported and the demonstrated effects of native vitamin D deficiency/insufficiency in most of the above mentioned fields, dealing separately with the MBM-related and the pleiotropic effects.

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Are low levels of 25-hydroxyvitamin D a risk factor for cardiovascular diseases or malignancies in renal transplantation?

Cited by 25 publications

References 25 publications

Vitamin D in Kidney Transplant Recipients: Mechanisms and Therapy

Vitamin D in Kidney Transplant Recipients: Mechanisms and Therapy

Mineral and bone disorder after kidney transplantation

Nutritional Vitamin D in Renal Transplant Patients: Speculations and Reality

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