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Is there a link between vitamin D status and kidney transplant outcome?

Posted on: April 17, 2013   by  John Cannell, MD


Renal transplantation is now a common procedure. End-stage renal disease is the reason for kidney transplantation. Causes of end-stage renal disease include untreated hypertension, infections, diabetes mellitus, and other rarer conditions. Diabetes accounts for one fourth of transplants. The majority of recipients are on dialysis at the time of surgery.

About one in three donors are living and give one of their kidneys away. A typical recipient will live up to 15 years longer after a kidney transplant than they would have if kept on dialysis alone. Transplant tourism is not uncommon, where recipients go to an undeveloped country to buy a kidney from a poverty stricken donor.

Few people know that kidney function or glomerular filtration rate (GFR) is highly seasonal with wintertime impairment and summertime improvements.

Masugata H et al. Seasonal variation in estimated glomerular filtration rate based on serum creatinine levels in hypertensive patients. Tohoku J Exp Med. 2011;224(2):137-42.

This month, Doctor Frank Bienaimé, working under senior author Professor Dominique Prié of the Université Paris Descartes in France looked at renal transplantation and vitamin D levels.

Bienaimé F, Girard D, Anglicheau D, Canaud G, Souberbielle JC, Kreis H, Noël LH, Friedlander G, Elie C, Legendre C, Prié D. Vitamin D Status and Outcomes After Renal Transplantation. J Am Soc Nephrol. 2013 Mar 28.

They studied 634 kidney recipients between January 2005 and June 2010. They measured 25(OH)D levels three months after surgery and followed the patients for an average of 4 years. Mean vitamin D levels at 3 months were low, 13 ng/ml, and less than 30 ng/ml in 92% of patients.

The authors found no association between 25(OH)D and survival or transplant rejections, but they did find significant independent associations of lower 25(OH)D levels with lower measured GFR at 12 months (P=0.001) and higher risk for interstitial fibrosis and tubular atrophy (P=0.01). To my knowledge, this was the first study to link vitamin D status with functional renal outcomes in such patients.

The authors concluded:

“Studies from our group and others have already shown that cholecalciferol supplementation is a safe way to increase 25 (OH)D concentrations in kidney transplant recipients, but the small number of treated patients included in these studies and their short follow-up do not allow any conclusion on the effect of these treatments on kidney function. Our results should encourage randomized controlled trials evaluating the effect of early cholecalciferol supplementation on renal allograft function and provide valuable information on the magnitude of the expected effects of such treatments on renal function and histologic features.”

2 Responses to Is there a link between vitamin D status and kidney transplant outcome?

  1. Rita and Misty

    How about giving Vitamin D Supplementation to those patients susceptible to chronic kidney disease prior to end stage CKD setting in? Perhaps this would eliminate, or substantially reduce, the number of cases requiring dialysis or transplant…

    Vitamin D supplementation in pre-dialysis chronic kidney disease: A systematic review


    Taken from the article:

    “With the increasing prevalence of obesity, hypertension, and type 2 diabetes, there has also been an increase in the prevalence of chronic kidney disease (CKD).1 Complications of CKD include progression to end stage renal disease and need for costly dialysis or renal transplantation, bone disease and premature cardiovascular disease (CVD) morbidity and mortality.2 Strategies to manage CKD are thus a high priority, not only from a clinical, but also a public health perspective.3 Vitamin D may play a key role in the disease management of CKD. Accumulating evidence from epidemiological and experimental research suggests that vitamin D is integral not only for its classical effects on the skeletal system, but also for its extra-skeletal benefits such as those on cardiovascular health and immune function.4,5 In this regard, a recent meta-analysis indicated that higher circulating 25-hydroxyvitamin D (25(OH)D or calcidiol) concentrations were associated with lower all-cause mortality risk in all stages of CKD.6”

  2. Rita and Misty

    Here’s another interesting article:

    Impact of vitamin D on proteinuria, insulin resistance, and cardiovascular parameters in kidney transplant recipients.


    Taken from the article:

    “In conclusion, vitamin D insufficiency was common and significantly associated with proteinuria among kidney transplant recipients.”

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