Nutritional Vitamin D in Renal Transplant Patients: Speculations and Reality

Messa, Piergiorgio; Regalia, Anna; Alfieri, Carlo

doi:10.3390/nu9060550

Cited by 21 publications

(18 citation statements)

References 84 publications

(108 reference statements)

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“…www.nature.com/scientificreports/ N-VitD at T12. At T12, average 25OHD levels were still low in the overall cohort 16 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] (p < 0.0001 vs 25OH-T1). At univariate regression, 25OHD-T12 was directly correlated with 25OHD-T1 (p < 0.0001) and inversely correlated with PTH-T1 and PTH-T12 (p < 0.0001 and p = 0.01 respectively).…”

Section: Resultsmentioning

confidence: 88%

Vitamin D and subclinical cardiac damage in a cohort of kidney transplanted patients: a retrospective observational study

Alfieri

Vettoretti

Ruzhytska

et al. 2020

Sci Rep

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In 178-kidney transplanted patients (KTxp), the prevalence of hypovitaminosis-D, the presence and novel development of left ventricular hypertrophy(LVH) and the correlations between native Vitamin-D (25OHD) and LVH were evaluated during the 1st year of transplantation (KTx). Clinical and instrumental data were recorded at pre-KTx and at one (T1) and 12 (T12) months after KTx. 25OHD levels were considered sufficient (s25OHD, ≥ 30 ng/dL) or insufficient (i25OHD, < 30 ng/dL). 25OHD correlated at T1 with parathormone(PTH), and at T12 with 25OHD-T1 and PTH-(T1,T12). At T12, s25OHD (15%) had higher 25OH and alkaline phosphatase (ALP), lower Ca, at T1, and lower PTH-(T1, T12) than i25OH-T12. At T1, KTxp with LVH (LVH-T1pos, 42%) were older and with longer dialysis vintage than LVH-T1neg. At T12, KTxp with LVH (LVH-T12pos, 53%) were older, with higher systolic blood pressure (SBP) at T12 than LVH-T12neg. No relation between 25OHD and LVH were found. Novel LVH was found in 14% of KTxp. They were older, had higher SBP-T12 and lower serum albumin-T12 than the others. LVH-modifications and 25OHD were not correlated. Hypovitaminosis-D is highly prevalent in KTxp. LVH correlates with different risk factors according to the time elapsed from KTx. However, during the 1st year of KTx, no relationship between LVH and 25OHD was observed.

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Section: Resultsmentioning

confidence: 88%

Vitamin D and subclinical cardiac damage in a cohort of kidney transplanted patients: a retrospective observational study

Alfieri

Vettoretti

Ruzhytska

et al. 2020

Sci Rep

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“…It is known that women tend to have lower levels of 25 (OH) D compared with men. 25 Although our group consisted entirely of Caucasians which would comprise the predominant ethnicity in the local population it is important to note that ethnic groups with dark skin-colour are more at risk of vitamin D deficiency as melanin is an effective natural sunscreen. 4 Vitamin D status is also affected by aging as levels of 7-dehydrocholesterol decline with age, so there is less substrate for cutaneous vitamin D production.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Short-Term Vitamin D Supplementation on Calcium Status in Vitamin D Insufficient Renal Transplant Recipients at Risk of Hypercalcemia

Cronin

Byrne

Doyle

et al. 2019

Journal of Renal Nutrition

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Insufficient Renal Transplant Recipients at risk of Hypercalcaemia. Objective: Vitamin D insufficiency is highly prevalent amongst renal transplant recipients and in observational studies is associated with adverse outcomes. Hypercalcaemia, usually due to persistent hyperparathyroidism, also commonly occurs in this population and often coexists with vitamin D insufficiency. However, concern that vitamin D supplementation might exacerbate the pre-existing hypercalcaemia often leads clinicians to avoid vitamin D supplementation in such patients. This feasibility study aimed to quantify the effect on serum calcium of short-term lowdose cholecalciferol supplementation in a group of renal transplant recipients with a recent history of serum calcium levels >10 mg/dL. Design: This was a two-week, single arm, open-label trial. Setting: Renal transplant follow-up clinic in an Irish University Hospital. Subjects: 18 vitamin D insufficient adult patients with a functioning renal allograft (eGFR > 30 ml/min/1.73m 2) and a recent history of serum calcium>10mg/dL. Intervention: Two weeks of treatment with 1000 IU cholecalciferol/day. Main Outcome Measure: Change in plasma ionized calcium and urine calcium:creatinine ratio at follow-up as compared to baseline. Results: The mean (sd) baseline 25 (OH) vitamin D (25 (OH) D) concentration was 15.9 (5.97) ng/mL and the mean (sd) baseline serum calcium was 10.50 (0.6) mg/dL. Following the 2-week intervention, median (IQR) change in serum calcium from baseline to follow-up was-0.08 (-3.6 to 0.08) mg/dL, p=0.3. Mean (sd) ionized calcium decreased from 5.24 (0.32) mg/dL at baseline 4 to 5.16 (0.28) mg/dL, p= 0.05. The median (IQR) change in the urinary calcium:creatinine ratio was 0.001 (-0.026 to 0.299) mg/mg, p=0.88. The median (IQR) change in 25 (OH) D was 3.6 (2.9 to 6.2) ng/mL, p<0.05. Conclusions: In vitamin D insufficient renal transplant recipients at risk of hypercalcaemia, lowdose short-term oral cholecalciferol supplementation improves 25 (OH) D concentrations without exacerbating hypercalcaemia or increasing the urinary calcium:creatinine ratio.

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“…First, low 1,25D levels may be a proxy of impaired proximal tubular function. Second, the renoprotective effects of 1,25D may contribute to its association 28 . Moreover, active vitamin D use served as a modifier for the relationship between 1,25D levels and outcome.…”

Section: Discussionmentioning

confidence: 99%

Serum phosphate levels modify the impact of parathyroid hormone levels on renal outcomes in kidney transplant recipients

Doi

Hamano

Ichimaru

et al. 2020

Sci Rep

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Separate assessment of mineral bone disorder (MBD) parameters including calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D (1,25D) predict renal outcomes in kidney transplant recipients (KTRs), with conflicting results. To date, data simultaneously evaluating these parameters and interwoven relations on renal outcomes are scarce. We conducted a prospective long-term follow-up cohort study included 263 KTRs with grafts functioning at least 1 year after transplantation. The outcome was a composite of estimated GFR halving and graft loss. Cox regression analyses were employed to evaluate associations between a panel of six MBD parameters and renal outcomes. The outcome occurred in 98 KTRs during a median follow-up of 10.7 years. In a multivariate Cox analysis, intact PTH (iPTH), phosphate, and 1,25D levels were associated with the outcome (hazard ratio, 1.60 per log scale; 95% confidence interval, 1.19–2.14, 1.60 per mg/dL; 1.14–2.23 and 0.82 per 10 pg/mL; 0.68–0.99, respectively). Competing risk analysis with death as a competing event yielded a similar result. After stratification into four groups by iPTH and phosphate medians, high risks associated with high iPTH was not observed in KTRs with low phosphate levels (P-interaction < 0.1). Only KTRs not receiving active vitamin D, poor 1,25D status predicted the worse outcome (P-interaction < 0.1). High iPTH, phosphate, and low 1,25D, but not FGF23, levels predicted poor renal outcomes. Simultaneous evaluation of PTH and phosphate levels may provide additional information regarding renal allograft prognosis.

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Nutritional Vitamin D in Renal Transplant Patients: Speculations and Reality

Cited by 21 publications

References 84 publications

Vitamin D and subclinical cardiac damage in a cohort of kidney transplanted patients: a retrospective observational study

Vitamin D and subclinical cardiac damage in a cohort of kidney transplanted patients: a retrospective observational study

The Effect of Short-Term Vitamin D Supplementation on Calcium Status in Vitamin D Insufficient Renal Transplant Recipients at Risk of Hypercalcemia

Serum phosphate levels modify the impact of parathyroid hormone levels on renal outcomes in kidney transplant recipients

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