Vitamin D Deficiency Predicts Decline in Kidney Allograft Function: A Prospective Cohort Study

Obi, Yoshitsugu; Hamano, Takayuki; Ichimaru, Naotsugu; Tomida, Kodo; Matsui, Isao; Fujii, Naohiko; Okumi, Masayoshi; Kaimori, Jun-Ya; Yazawa, Koji; Kokado, Yukito; Nonomura, Norio; Rakugi, Hiromi; Takahara, Shiro; Isaka, Yoshitaka; Tsubakihara, Yoshiharu

doi:10.1210/jc.2013-2421

Cited by 52 publications

(63 citation statements)

References 43 publications

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“…In PD patients, low vitamin D levels have been associated with cognitive impairment [42]. In transplant recipients, low serum 25(OH)D level is associated with a rapid decline in renal function [46,47]. Vitamin D deficiency has been associated with insulin resistance, ventricular hypertrophy, atherosclerotic disease [38], and vascular calcifications [39].…”

Section: Consequences Of Low Serum 25(oh)d Levels In Ckd and Dialymentioning

confidence: 99%

Vitamin D in Chronic Kidney Disease and Dialysis Patients

2017

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Vitamin D deficiency (<20 ng/mL) and insufficiency (20–29 ng/mL) are common among patients with chronic kidney disease (CKD) or undergoing dialysis. In addition to nutritional and sunlight exposure deficits, factors that affect vitamin D deficiency include race, sex, age, obesity and impaired vitamin D synthesis and metabolism. Serum 1,25(OH)2D levels also decrease progressively because of 25(OH)D deficiency, together with impaired availability of 25(OH)D by renal proximal tubular cells, high fibroblast growth factor (FGF)-23 and decreased functional renal tissue. As in the general population, this condition is associated with increased morbidity and poor outcomes. Together with the progressive decline of serum calcitriol, vitamin D deficiency leads to secondary hyperparathyroidism (SHPT) and its complications, tertiary hyperparathyroidism and hypercalcemia, which require surgical parathyroidectomy or calcimimetics. Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease Improving Global Outcomes (KDIGO) experts have recognized that vitamin D insufficiency and deficiency should be avoided in CKD and dialysis patients by using supplementation to prevent SHPT. Many vitamin D supplementation regimens using either ergocalciferol or cholecalciferol daily, weekly or monthly have been reported. The benefit of native vitamin D supplementation remains debatable because observational studies suggest that vitamin D receptor activator (VDRA) use is associated with better outcomes and it is more efficient for decreasing the serum parathormone (PTH) levels. Vitamin D has pleiotropic effects on the immune, cardiovascular and neurological systems and on antineoplastic activity. Extra-renal organs possess the enzymatic capacity to convert 25(OH)D to 1,25(OH)2D. Despite many unanswered questions, much data support vitamin D use in renal patients. This article emphasizes the role of native vitamin D replacement during all-phases of CKD together with VDRA when SHPT persists.

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Section: Consequences Of Low Serum 25(oh)d Levels In Ckd and Dialymentioning

confidence: 99%

Vitamin D in Chronic Kidney Disease and Dialysis Patients

2017

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“…The immunologic effects of vitamin D deficiency in the kidney transplant population – where end-stage renal disease leads to dysregulation of vitamin D metabolism – can persist well beyond successful transplantation of a renal allograft. Low vitamin D levels are predictive for deterioration in allograft glomerular filtration rate 246,247 and correlate with acute rejection, infection, and mortality in lung transplant patients 248 . Given the potentially significant immunologic impact of vitamin D deficiency and the safety of vitamin D supplementation, normalization of vitamin D levels should be recommended in the transplant population.…”

Section: Vitamin Dmentioning

confidence: 99%

Impact of Immune-Modulatory Drugs on Regulatory T Cell

2016

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Immunosuppression strategies that selectively inhibit effector T cells while preserving and even enhancing CD4+FOXP3+ regulatory T cells (Treg) permit immune self-regulation and may allow minimization of immunosuppression and associated toxicities. Many immunosuppressive drugs were developed before the identity and function of Treg were appreciated. A good understanding of the interactions between Treg and immunosuppressive agents will be valuable to the effective design of more tolerable immunosuppression regimens. This review will discuss preclinical and clinical evidence regarding the influence of current and emerging immunosuppressive drugs on Treg homeostasis, stability, and function as a guideline for the selection and development of Treg-friendly immunosuppressive regimens.

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“…The strength of the association between 25(OH)D levels and graft function may be negatively influenced by the length of follow-up. Obi et al [63] Vitamin D in KTRs [64] . No associations between 1,25(OH) 2 D 3 levels and GFR trends have been observed in KTRs [21] .…”

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

confidence: 99%

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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Vitamin D Deficiency Predicts Decline in Kidney Allograft Function: A Prospective Cohort Study

Abstract: Vitamin D deficiency predicts a rapid decline in eGFR and need for IV-MP at less than 10 years after KTx. Future studies are warranted to evaluate the clinical efficacy of vitamin D supplementation.

Cited by 52 publications

References 43 publications

Vitamin D in Chronic Kidney Disease and Dialysis Patients

Vitamin D in Chronic Kidney Disease and Dialysis Patients

Impact of Immune-Modulatory Drugs on Regulatory T Cell

Vitamin D in Kidney Transplant Recipients: Mechanisms and Therapy

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