Vitamin D Deficiency Is an Independent Risk Factor for Urinary Tract Infections After Renal Transplants

Abstract

Vitamin D deficiency is frequently found in patients with renal transplants (RTxs). Because vitamin D plays indispensable roles in the immune system, there may be an association between vitamin D deficiency and infection in these patients, but this has not been fully elucidated. Therefore, this study investigated the impact of pre-RTx vitamin D deficiency on urinary tract infection (UTI) development after RTx.We measured 25-hydroxyvitamin D3 (25(OH)D3) levels in 410 patients 2 weeks before they underwent RTx. Vitamin D deficiency was defined as 25(OH)D3 <10 ng/mL. The primary outcome was UTI occurrence after RTx. Cox proportional hazard analysis determined whether vitamin D deficiency was independently associated with UTI.The mean 25(OH)D3 level was 12.8 ± 6.9 ng/mL, and 171 patients (41.7%) were vitamin D deficient. During a median follow-up duration of 7.3 years, the UTI incidence was significantly higher in vitamin D-deficient patients (52 patients, 30.4%) compared with vitamin D-nondeficient patients (40 patients, 16.7%) (P = 0.001). Moreover, multivariate Cox proportional hazard analysis showed that vitamin D deficiency was an independent predictor of UTI after RTx (hazard ratio 1.81, 95% confidence interval 1.11–2.97, P = 0.02).Vitamin D deficiency was an independent risk factor for UTI after RTx; hence, determining 25(OH)D3 levels might help to predict infectious complications after RTx.

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

“…Biological plausibility was supported by the dose‐response gradient observed between lower quartiles of serum 25(OH)D levels and infection susceptibility, with a 24% decrease in the risk of overall infection per each one‐quartile increase. Our results reinforce recent studies suggesting the clinical relevance of the immunomodulatory role attributable to vitamin D in the setting of ongoing immunosuppression after KT.…”

“…In a single‐center retrospective study, Park et al found serum 25(OH)D levels <20 ng/mL at baseline were associated with a higher incidence of bacterial infection and, specifically, urinary tract infection (UTI). Similar findings were reported by Kwon et al, although restricted to late‐onset UTI episodes. Rech et al demonstrated in a small cohort of KT recipients a significant association between serum 25(OH)D levels <20 ng/mL (measured 30 days before or after transplantation) and the occurrence of opportunistic viral infection.…”

“…Vitamin D deficiency is common among patients with ESRD, and such status may persist after KT . Recent studies have reported an increased risk of infection for vitamin D‐deficient KT recipients . However, many of these studies only assessed baseline vitamin D levels .…”

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

“…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 .…”

“…In the general population, deficiency of vitamin D has been associated with a higher risk of infections . Among kidney transplant recipients, some studies indicate a relevance of 25‐OHD levels for infections overall, bacterial infections, urinary tract infections, and opportunistic viral infections . Other studies could not identify an association between vitamin D status and infections after kidney transplantation .…”