•  
  •  
 

Abstract

Background: Recent studies have observed that vitamin D insufficiency is quite common among kidney transplant recipients (KTRs) and has several deleterious effects. Objective: This study aimed to assess vitamin D (VD) status and investigate its relationships with various health variables in KTRs in Erbil, Iraq. Methods: This observational cross-sectional study enrolled 130 consecutive KTRs; their mean age was 39.2 + 11.3 years, and 56.9% were men. Demographic data, comorbidities, and baseline clinical and laboratory characteristics were obtained, recorded, and analyzed. The value of 25-hydroxyvitamin D [25(OH)D] > 30 ng/mL was considered sufficient, values of 15-30 ng/mL were insufficient, and a value of /mL was deficient. The participants were divided into two groups: VD-deficient and non-deficient, based on their VD status. Results: A significant proportion (106/130, 81.6%) of the participants had a suboptimal vitamin VD level; VD deficiency was detected in 34 (26.2%) KTRs, and insufficiency was demonstrated in 72 (55.4%) participants. On a densitometry study of bone mineral density (BMD) of 70 participants, 42 (60%) showed osteopenia, 21 (30%) osteoporosis, and only 7 (10%) displayed normal BMD. Conclusion: Suboptimal VD levels is quite common among KTRs, and the VD-deficient KTRs are more likely to be women, diabetics, osteoporotic, have had episodes of rejection, and have higher intact parathyroid hormone levels. Regular 25(OH) D checking in KTRs might allow for more efficient identification of VD status and could assist in guiding preventive and therapeutic strategies.

References

[1] Teh JW, Mac Gearailt C, Lappin DWP. Post-transplant bone disease in kidney transplant recipients: diagnosis and management. Int J Mol Sci 2024;25(3):1859. https://doi.org/ 10.3390/ijms25031859.

[2] Cao H, Zhang J, Sun Z, Wu J, Hao C, Wang W. Frailty in kidney transplant candidates and recipients: pathogenesis and intervention strategies. Chin Med J (Engl) 2023 May 5; 136(9):1026—36. https://doi.org/10.1097/CM9.00000000000 02312.

[3] Koimtzis G, Stefanopoulos L, Brooker V, Geropoulos G, Chalklin CG, Gupta S, et al. The role of vitamin D in kidney transplantation outcomes: a systematic review. Life (Basel) 2022;12:1664. https://doi.org/10.3390/life12101664.

[4] Yin S, Wang X, Li L, Huang Z, Fan Y, Song T, Lin T. Prevalence of vitamin D deficiency and impact on clinical outcomes after kidney transplantation: a systematic review and meta-analysis. Nutr Rev 2022;80(4):950—61. https://doi.org/ 10.1093/nutrit/nuab058. PMID: 34472620.

[5] Bai Y-J, Li Y-M, Hu S-M, Zou Y-G, An Y-F, Wang L-L, et al. Vitamin D supplementation reduced blood inflammatory cytokines expression and improved graft function in kidney transplant recipients. Front Immunol 2023;14:1152295. https://org.doi/10.3389/fimmu.2023.1152295.

[6] Pascale Khairallah, Nickolas Thomas L. Bone and Mineral disease in kidney transplant recipients. CJASN 2022;17(1): 121—30. https://doi.org/10.2215/CJN.03410321.

[7] Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD update work group. KDIGO 2017 clinical practice guideline update for diagnosis, evaluation, prevention and treatment of chronic kidney disease mineral bone disorder (CKD-MBD). Kidney Int Suppl 2017;7:1—59. https:// doi.org/10.1016/j.kisu.2017.04.001.

[8] Tsujita M, Doi Y, Obi Y, Hamano T, Tomosugi T, Futamura K, et al. Cholecalciferol supplementation attenuates bone loss in incident kidney transplant recipients: a prespecified secondary endpoint analysis of a randomized controlled trial. J Bone Miner Res 2022 Feb;37(2):303—11. https://doi.org/10.1002/jbmr.4469. https://org.

[9] Zimmerman D, House AA, Kim SJ, Booth RA, Zhang T, Ramsay T, et al. The risk of acute rejection following kidney transplant by 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D status: A prospective cohort study. Can J Kidney Health Dis 2017;4:2054358117699822. https://doi.org/10.1177/ 2054358117699822.

[10] Cianociolo G, Galassi A, Capelli I, Angelini ML, La Manna G, Cozzolino M. Vitamin D in kidney transplant recipients: mechanisms and therapy. AJN 2016;43(6): 397—407. https://doi.org/10.1159/000446863.

[11] Filipov JJ, Dimitrov EP. Vitamin D after kidney transplantation: metabolism and clinical importance. EMJ Nephrol 2017;5(1):75—82. https://doi.org/10.33590/emjneph rol/10311600. 10311600.

[12] Rosina KT, Barreto AP, Pontes KS, Martins M, Souza E, Bregman R, et al. Vitamin D status in renal transplant recipients living in a low-latitude city: association with body fat, cardiovascular risk factors, estimated glomerular filtration rate, and proteinuria. Br J Nutr 2017;117:1279—90. https://doi.org/10.1017/S000711451700112X.

[13] Souberbielle JC, Massart C, Brailly-Tabard S, Cavalier E, Chanson P. Prevalence and determinants of vitamin D deficiency in healthy French adults: the VARIETE study. Endocrine 2016;53:543—50. https://doi.org/10.1007/s12020- 016-0960-3.

[14] Mirzakhani M, Mohammadkhani S, Hekmatirad S, Aghapour S, Gorjizaden N, Shahbazi M, et al. The association between vitamin D and acute rejection in human kidney transplantation: a systematic review and metaanalysis study. Transpl Immunol 2021;67:101410. https://doi. org/10.1016/j.trim.2021.101410.

[15] Mehrotra S, Sharma RK, Gupta A, Prassad N, Rhadauria DS, Kaul A, et al. Low 25 (OH) Vit D levels are associated with inferior graft function in living-related kidney transplant recipients. J Ren Inj Prev 2018;7:224—9. https://doi.org/10.15171/jrip-2018-52.

[16] Thorsen IS, Bleskestad IH, Asberd A, Hartman A, Skadberg O, Brede C, et al. Vitamin D as a risk factor for patient survival after kidney transplantation: Prospective observational cohort study. Clin Transplant 2019;33:e13517. https://doi.org/10.1111/ctr.13517.

[17] Taderegew MM, Woldeamanuel GG, Wondie A, Getawey A, Abegaz AN, Adane F. Vitamin D deficiency and its associated factors among patients with type 2 diabetes mellitus: a systematic review and meta-analysis. BMJ Open 2023 Oct 5;13(10):e075607. https://org.doi/10.1136/bmjopen2023-075607.

[18] Han A, Park Y, L YK, Park SY, Park CY. Positive statement: vitamin D intake to prevent osteoporosis and fractures in adults. J Bone Metab 2022 Nov;29(4):205—15. https://doi.org/ 10.11005/jbm.2022.29.4.205.

[19] Erdem BK, Yilmaz VT, Suleymanlar G, Ozcan F, Ataman AB, Akbas H, et al. The relationship between vitamin D status and graft function in renal transplant recipients. Int J Med Biochem 2018;1(1):1—5. https://doi.org/ 10.14744/ijmb.2017.98608.

[20] Buyukdemirci S, Oguz EG, Cimen SG, Sahin H, Cimen S, Ayl MD. Vitamin D deficiency may predispose patients to an increased risk of kidney transplant rejection. World J Transplant 2022;12(9):299—309. https://doi.org/10.5500/wjt. v12.i9.299

Download

Share

COinS