Vitamin D deficiency and infection risk in kidney transplant recipients: A single‐center cohort study

Fernández‐Ruiz, Mario; Corbella, Laura; Morales-Cartagena, Alejandra; González, Esther; Polanco, Natalia; Ruiz‐Merlo, Tamara; Parra, Patricia; Silva, Jose T.; López‐Medrano, Francisco; Juan, Rafael San; Aramendi, Mercedes; Andrés, Amado; Aguado, José María

doi:10.1111/tid.12988

Cited by 9 publications

(9 citation statements)

References 40 publications

(91 reference statements)

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“…Notably, also in an additional analysis of opportunistic infections, we could not detect an association with vitamin D status (Table S1). These findings are in line with the results of Ban Th et al Few studies, most of them based on retrospective data collection, reported an association between vitamin D deficiency and infections . The cutoff value used for definition of vitamin D deficiency in our study is based on studies that considered dynamics in bone turnover variables .…”

Section: Discussionsupporting

confidence: 92%

“…These findings are in line with the results of Ban Th et al 20 Few studies, most of them based on retrospective data collection, reported an association between vitamin D deficiency and infections. 4,6,21 The cutoff value used for definition of vitamin D deficiency in our study is based on studies that considered dynamics in bone turnover variables. 11 Up to now, no cutoff has been specifically established for infectious risk stratification by vitamin D status.…”

Section: Discussionmentioning

confidence: 99%

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Vitamin D deficiency is common in kidney transplant recipients, but is not associated with infections after transplantation

Schreiber

Kusejko

Bischoff‐Ferrari³

et al. 2020

Clinical Transplantation

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The relevance of vitamin D for infections after kidney transplantation is poorly defined. 25‐OH vitamin D (25‐OHD) levels of 135 kidney transplant recipients, enrolled in the Swiss Transplant Cohort Study, were determined peri‐transplant and 6 months post‐transplant. Logistic regression was used to address the associations of 25‐OHD and overall infections and bacterial infections, respectively. For the first 6 months post‐transplant, 25‐OHD peri‐transplant, and for the second period (after 6 to 30 months post‐transplant), 25‐OHD at 6 months post‐transplant was considered. Vitamin D deficiency was common peri‐transplant and remained highly prevalent 6 months after transplantation despite frequent supplementation. Median 25‐OHD levels increased from 12.0 ng/mL (IQR 5.3‐19.5) peri‐transplant to 16.5 ng/mL (IQR 10.6‐22.6) 6 months post‐transplant (P = .005). We did not detect a significant association between 25‐OHD and overall infections (adjusted odds ratio (aOR) 1.05, 95% confidence interval (95%CI) 0.44‐2.51; aOR 0.67, 95%CI 0.31‐1.43) or bacterial infections (aOR 0.79, 95%CI 0.32‐1.96; aOR 0.79, 95%CI 0.35‐1.75) for the first and second period. To conclude, at both time points, vitamin D deficiency was observed in more than 50% of kidney recipients, albeit an increase in 25‐OHD in the longitudinal course was observed. No significant association between 25‐OHD and infections was detected.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Vitamin D deficiency is common in kidney transplant recipients, but is not associated with infections after transplantation

Schreiber

Kusejko

Bischoff‐Ferrari³

et al. 2020

Clinical Transplantation

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“…Infection is a major cause for death after KT. Several recent reports established negative correlation between VD status and infection risk, especially for cytomegalovirus and BK virus infections in KTRs [91,92]. However, our observational study showed no association between VD status and prevalence of urinary tract infections after KT [93].…”

Section: Vd Pleiotropy After Kt: Infectioncontrasting

confidence: 72%

Vitamin D Deficiency in Renal Disease

Filipov¹,

Dimitrov²

2020

Vitamin D Deficiency

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Vitamin D deficiency is highly prevalent in patients with renal disease. The abnormal vitamin D (VD) metabolism in chronic kidney disease (CKD) is a key factor for developing CKD-related mineral bone disease (CKD-MBD), which directly influences the survival of the CKD patients. The importance of VD is perhaps of greater value due to its pleiotropic effects that span beyond calcium-phosphorus metabolism (cancer protection, diabetes prevention, and renal protection). The aim of our chapter is to depict the clinical implications of VD deficiency in the setting of CKD, including VD pleiotropy in renal disease, and to propose the most adequate treatment suggested in the literature. Keywords: vitamin D deficiency, chronic kidney disease, mineral bone disease, vitamin D pleiotropy, vitamin D supplementationVitamin D Deficiency 2 the ratio between free and total 25VD remained unchained; therefore, total 25VD is the indicator of VD status in CKD [3].Generally, 25VD level has reverse association with parathyroid hormone (PTH) levels. In addition, higher 25VD is associated with higher calcium intestinal reabsorption. However, at 25VD ≥ 75 nmol/l, no reduction in PTH levels and no increase in calcium intestinal reabsorption occurs [4, 5]. Therefore, 25VD ≥ 75 nmol/l is regarded as a cut-off value for vitamin D sufficiency.No generally accepted definition for VD deficiency exists, as authors choose cut-off value either serum 25VD of 25 nmol/L [6] or serum 25VD of 50 nmol/L [7]. However, target levels of 75 nmol/L are recommended, taking into consideration the clinical importance of mild VD insufficiency (25VD between 50 and 74.9 nmol/L) [7,8].Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for more than 3 months, with implications for health [one of the following: estimated glomerular filtration rate (eGFR) less than 60 ml/ min/1.73 m 2 ,presence of proteinuria, structural abnormalities of the kidney detected on imaging, pathological findings detected on kidney biopsy, urine sediment pathology, electrolyte abnormalities due to tubular disorders, history of kidney transplantation] [9]. CKD patients are at increased risk for VD deficiency; therefore, they require VD screening [7]. Vitamin D metabolism in health and renal disease VD metabolism in healthy subjectsVD is synthesized predominantly endogenously (approx. to 90% of the total VD in human body). In the skin, the ultraviolet light transforms 7-dehydroxycholesterol (provitamin D) to pre-vitamin D, which under the influence of body temperature spontaneously isomerizes to cholecalciferol (vitamin D3). Approximately, 10% of total body VD is taken orally (vitamin D2, ergocalciferol, and cholecalciferol). VD is transported via VD-binding protein to the liver, where it is hydroxylated to 25VD. The next step in VD activation is hydroxylation of 25VD by the enzyme 1α-hydroxylase (CYP27B1) to 1,25VD, which is the active VD metabolite. The process occurs predominantly in the renal tubules. In addition, non-renal CYP27B1 was detected...

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“…Since vitamin D regulates the immune system, alteration in its level affects the outcome of allografts, e.g., acute cellular rejection (ACR) and infection [ 39 ]. Similarly, several other studies reported that transplanted patients have a higher risk of infections [ 36 , 37 , 167 , 168 , 169 ] and rejections [ 38 , 170 ]. Thus, vitamin D supplementation and tight follow-up of its level is important in transplant recipient patients [ 39 ].…”

Section: Vitamin D and Sirt1 In Relation To Non-communicable Diseases...mentioning

confidence: 70%

“…Many of these are associated with a reduced level of SIRT1 as well [ 34 , 35 ]. Vitamin D levels may influence the risk of infections in kidney and liver transplant recipients [ 36 , 37 ] and the risk of acute rejection [ 38 , 39 ] and of new-onset diabetes after kidney transplantation [ 40 ].…”

Section: Introductionmentioning

confidence: 99%

Interplay of Vitamin D and SIRT1 in Tissue-Specific Metabolism—Potential Roles in Prevention and Treatment of Non-Communicable Diseases Including Cancer

Németh

Patonai

Simon-Szabó

et al. 2023

IJMS

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The importance of the prevention and control of non-communicable diseases, including obesity, metabolic syndrome, type 2 diabetes, cardiovascular diseases, and cancer, is increasing as a requirement of the aging population in developed countries and the sustainability of healthcare. Similarly, the 2013–2030 action plan of the WHO for the prevention and control of non-communicable diseases seeks these achievements. Adequate lifestyle changes, alone or with the necessary treatments, could reduce the risk of mortality or the deterioration of quality of life. In our recent work, we summarized the role of two central factors, i.e., appropriate levels of vitamin D and SIRT1, which are connected to adequate lifestyles with beneficial effects on the prevention and control of non-communicable diseases. Both of these factors have received increased attention in relation to the COVID-19 pandemic as they both take part in regulation of the main metabolic processes, i.e., lipid/glucose/energy homeostasis, oxidative stress, redox balance, and cell fate, as well as in the healthy regulation of the immune system. Vitamin D and SIRT1 have direct and indirect influence of the regulation of transcription and epigenetic changes and are related to cytoplasmic signaling pathways such as PLC/DAG/IP3/PKC/MAPK, MEK/Erk, insulin/mTOR/cell growth, proliferation; leptin/PI3K-Akt-mTORC1, Akt/NFĸB/COX-2, NFĸB/TNFα, IL-6, IL-8, IL-1β, and AMPK/PGC-1α/GLUT4, among others. Through their proper regulation, they maintain normal body weight, lipid profile, insulin secretion and sensitivity, balance between the pro- and anti-inflammatory processes under normal conditions and infections, maintain endothelial health; balance cell differentiation, proliferation, and fate; and balance the circadian rhythm of the cellular metabolism. The role of these two molecules is interconnected in the molecular network, and they regulate each other in several layers of the homeostasis of energy and the cellular metabolism. Both have a central role in the maintenance of healthy and balanced immune regulation and redox reactions; therefore, they could constitute promising targets either for prevention or as complementary therapies to achieve a better quality of life, at any age, for healthy people and patients under chronic conditions.

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Vitamin D deficiency and infection risk in kidney transplant recipients: A single‐center cohort study

Abstract: Vitamin D status influences the risk of infection among KT recipients, with the association being particularly evident for opportunistic events and mainly restricted to the early post-transplant period.

Cited by 9 publications

References 40 publications

Vitamin D deficiency is common in kidney transplant recipients, but is not associated with infections after transplantation

Vitamin D deficiency is common in kidney transplant recipients, but is not associated with infections after transplantation

Vitamin D Deficiency in Renal Disease

Interplay of Vitamin D and SIRT1 in Tissue-Specific Metabolism—Potential Roles in Prevention and Treatment of Non-Communicable Diseases Including Cancer

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