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Segon B, Lam L, Chan HY, Andersen S, Brown T, Kenway D, Bauer J. Vitamin requirements during stem cell transplantation: a systematic review. Support Care Cancer 2022; 30:10391-10405. [PMID: 36347993 PMCID: PMC9715522 DOI: 10.1007/s00520-022-07409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
Patients undergoing stem cell transplantation (SCT) are at high risk of malnutrition during the acute post-transplantation period. This systematic review aimed to collate and analyse the evidence for vitamin requirements post-SCT. A systematic search of five databases was conducted to include studies published until March 2021. The review utilised the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) framework. Inclusion criteria consisted of adults undergoing SCT who received vitamin supplementation or had their vitamin levels monitored up to 100 days post-SCT. Studies with paediatric patients or those that looked at vitamin derivates such as folinic acid were excluded. Main outcomes included vitamin deficiency and relevant clinical outcomes. Eleven studies (n = 11) were eligible for inclusion with five rated as neutral quality and six as positive quality. Five studies focused on allogenic SCT, two on autologous SCT and the remaining included a mix of both. Eight studies monitored vitamins levels post-SCT, and seven studies provided vitamin supplementation. Three studies (one provided supplementation) found a high prevalence of vitamin D deficiency (23-60%) prior to SCT. Findings indicate an unclear association between vitamin deficiency and post-SCT complications including acute graft-versus-host-disease, oral mucositis, and mortality. The GRADE certainty of evidence across these outcomes was low or very low. It is unclear if supplementation is needed during SCT, though assessing vitamin D levels prior to transplant should be considered. Further large observational studies or randomised control trials are required to establish vitamin requirements and guide supplementation protocols during SCT.
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Affiliation(s)
- Bronwyn Segon
- grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, QLD Australia
| | - Leroy Lam
- grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, QLD Australia
| | - Hei Yan Chan
- grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, QLD Australia
| | - Sarah Andersen
- grid.416100.20000 0001 0688 4634The Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
| | - Teresa Brown
- grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, QLD Australia ,grid.416100.20000 0001 0688 4634The Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
| | - D’Arcy Kenway
- grid.1003.20000 0000 9320 7537The University of Queensland, Brisbane, QLD Australia
| | - Judy Bauer
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, VIC Australia
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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 2021; 80:950-961. [PMID: 34472620 DOI: 10.1093/nutrit/nuab058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT The prevalence of vitamin D deficiency (VDD) and its impact on clinical outcomes after kidney transplant (KT) remain poorly defined. OBJECTIVES We conducted a meta-analysis to evaluate the impact of early VDD on clinical outcomes after KT. DATA SOURCES Electronic databases (PubMed, Embase, Web of Science, and The Cochrane Library) were systematically searched for eligible publications up to April 30, 2020. DATA EXTRACTION Relative risk was presented as hazard ratios (HRs) or odds ratios (ORs) and 95%CIs for dichotomous outcomes. Mean difference (MD) and 95%CIs were presented for continuous outcomes. RESULTS A total of 28 studies (13 prospective and 15 retrospective) were included. VDD was common early after KT, with a prevalence of 52% (95%CI: 41%-64%) at transplant, 34% (95%CI: 17%-51%) at 3 months, and 23% (95%CI: 10%-35%) at 6 months. Early VDD was associated with higher mortality rate after KT (HR, 1.56; 95%CI: 1.32-1.84; P < 0.001). In addition, early VDD led to higher risk of bacterial infection (OR, 1.82; 95%CI: 1.40-2.36; P < 0.001), BK polyomavirus infection (OR, 2.11, 95%CI: 1.23-3.61; P = 0.006), and cytomegalovirus infection (OR, 1.69; 95%CI: 1.24-2.31; P = 0.001). Early VDD increased the risk of acute rejection as well (HR, 2.28; 95%CI: 1.57-3.30; P < 0.001). Recipients with early VDD had lower estimated glomerular filtration rates (mean difference: -5.06; 95%CI: -7.28 to 2.83 mL/min; P < 0.001). Sensitivity analyses showed good stability of the pooled results. CONCLUSION VDD was common early after KT and associated with higher risk of death and adverse outcomes.
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Affiliation(s)
- Saifu Yin
- Urology Department, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Urology Research Institute, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Xianding Wang
- Urology Department, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Urology Research Institute, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Linde Li
- Urology Department, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Urology Research Institute, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Zhongli Huang
- Urology Department, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Urology Research Institute, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Yu Fan
- Urology Department, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Urology Research Institute, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Turun Song
- Urology Department, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Urology Research Institute, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Tao Lin
- Urology Department, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Urology Research Institute, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
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Thorsen IS, Bleskestad IH, Åsberg A, Hartmann A, Skadberg Ø, Brede C, Ueland T, Pasch A, Reisæter AV, Gøransson LG. Vitamin D as a risk factor for patient survival after kidney transplantation: A prospective observational cohort study. Clin Transplant 2019; 33:e13517. [DOI: 10.1111/ctr.13517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/08/2019] [Accepted: 02/27/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Inga S. Thorsen
- Department of Internal Medicine Stavanger University Hospital Stavanger Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Inger H. Bleskestad
- Department of Internal Medicine Stavanger University Hospital Stavanger Norway
| | - Anders Åsberg
- Department of Transplantation Medicine Oslo University Hospital Oslo Norway
- Department of Pharmaceutical Biosciences, School of Pharmacy University of Oslo Oslo Norway
- Norwegian Renal Registry Oslo Norway
| | - Anders Hartmann
- Department of Transplantation Medicine Oslo University Hospital Oslo Norway
- Medical Faculty, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Øyvind Skadberg
- Department of Medical Biochemistry Stavanger University Hospital Stavanger Norway
| | - Cato Brede
- Department of Medical Biochemistry Stavanger University Hospital Stavanger Norway
| | - Thor Ueland
- Medical Faculty, Institute of Clinical Medicine University of Oslo Oslo Norway
- Research Institute of Internal Medicine University of Oslo Oslo Norway
| | | | - Anna V. Reisæter
- Department of Transplantation Medicine Oslo University Hospital Oslo Norway
- Norwegian Renal Registry Oslo Norway
| | - Lasse G. Gøransson
- Department of Internal Medicine Stavanger University Hospital Stavanger Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
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Sarno G, Nappi R, Altieri B, Tirabassi G, Muscogiuri E, Salvio G, Paschou SA, Ferrara A, Russo E, Vicedomini D, Vincenzo C, Vryonidou A, Della Casa S, Balercia G, Orio F, De Rosa P. Current evidence on vitamin D deficiency and kidney transplant: What's new? Rev Endocr Metab Disord 2017; 18:323-334. [PMID: 28281103 DOI: 10.1007/s11154-017-9418-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Kidney transplant is the treatment of choice for end-stage chronic kidney disease. Kidneys generate 1,25-dihydroxyvitamin D (calcitriol) from 25-hydroxyvitamin D (calcidiol) for circulation in the blood to regulate calcium levels. Transplant patients with low calcidiol levels have an increased risk of metabolic and endocrine problems, cardiovascular disease, type 2 diabetes mellitus, poor graft survival, bone disorders, cancer, and mortality rate. The recommended calcidiol level after transplant is at least 30 ng/mL (75 nmol/L), which could require 1000-3000 IU/d vitamin D3 to achieve. Vitamin D3 supplementation studies have found improved endothelial function and acute rejection episodes. However, since kidney function may still be impaired, raising calcidiol levels may not lead to normal calcitriol levels. Thus, supplementation with calcitriol or an analog, alfacalcidiol, is often employed. Some beneficial effects found include possible improved bone health and reduced risk of chronic allograft nephropathy and cancer.
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Affiliation(s)
- Gerardo Sarno
- General Surgery and Transplantation Unit - "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131, Salerno, Italy.
| | - Riccardo Nappi
- General Surgery and Transplantation Unit - "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131, Salerno, Italy
- Nephrology and Dialisys Unit - "Santa Maria della Misericordia" Hospital, ASUIUD - Udine, Udine, Italy
| | - Barbara Altieri
- Institute of Medical Pathology, Division of Endocrinology and Metabolic Diseases, Catholic University, Rome, Italy
| | - Giacomo Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | - Gianmaria Salvio
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristide Ferrara
- General Surgery and Transplantation Unit - "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131, Salerno, Italy
| | - Enrico Russo
- General Surgery and Transplantation Unit - "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131, Salerno, Italy
| | - Daniela Vicedomini
- General Surgery and Transplantation Unit - "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131, Salerno, Italy
| | - Cerbone Vincenzo
- General Surgery and Transplantation Unit - "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131, Salerno, Italy
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Silvia Della Casa
- Institute of Medical Pathology, Division of Endocrinology and Metabolic Diseases, Catholic University, Rome, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Orio
- Endocrinology, Department of Sports Science and Wellness, "Parthenope" University Naples, Naples, Italy
| | - Paride De Rosa
- General Surgery and Transplantation Unit - "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131, Salerno, Italy
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5
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Vilarta CF, Unger MD, dos Reis LM, Dominguez WV, David-Neto E, Moysés RM, Titan S, Custodio MR, Hernandez MJ, Jorgetti V. Hypovitaminosis D in patients undergoing kidney transplant: the importance of sunlight exposure. Clinics (Sao Paulo) 2017; 72:415-421. [PMID: 28793001 PMCID: PMC5525167 DOI: 10.6061/clinics/2017(07)05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/14/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES: Recent studies have shown a high prevalence of hypovitaminosis D, defined as a serum 25-hydroxyvitamin D level less than 30 ng/ml, in both healthy populations and patients with chronic kidney disease. Patients undergoing kidney transplant are at an increased risk of skin cancer and are advised to avoid sunlight exposure. Therefore, these patients might share two major risk factors for hypovitaminosis D: chronic kidney disease and low sunlight exposure. This paper describes the prevalence and clinical characteristics of hypovitaminosis D among patients undergoing kidney transplant. METHODS: We evaluated 25-hydroxyvitamin D serum levels in a representative sample of patients undergoing kidney transplant. We sought to determine the prevalence of hypovitaminosis D, compare these patients with a control group, and identify factors associated with hypovitaminosis D (e.g., sunlight exposure and dietary habits). RESULTS: Hypovitaminosis D was found in 79% of patients undergoing kidney transplant, and the major associated factor was low sunlight exposure. These patients had higher creatinine and intact parathyroid hormone serum levels, with 25-hydroxyvitamin D being inversely correlated with intact parathyroid hormone serum levels. Compared with the control group, patients undergoing kidney transplant presented a higher prevalence of 25-hydroxyvitamin D deficiency and lower serum calcium, phosphate and albumin but higher creatinine and intact parathyroid hormone levels. CONCLUSIONS: Our results confirmed the high prevalence of hypovitaminosis D in patients undergoing kidney transplant. Therapeutic strategies such as moderate sunlight exposure and vitamin D supplementation should be seriously considered for this population.
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Affiliation(s)
- Cristiane F. Vilarta
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marianna D. Unger
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciene M. dos Reis
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Wagner V. Dominguez
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Elias David-Neto
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rosa M. Moysés
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Mestrado em Medicina, Universidade Nove de Julho (UNINOVE), Sao Paulo, SP, BR
| | - Silvia Titan
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Melani R. Custodio
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Mariel J. Hernandez
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - Vanda Jorgetti
- Divisao de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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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; 117:1279-1290. [DOI: 10.1017/s000711451700112x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractRecent evidence suggests that vitamin D deficiency is associated with CVD, impaired kidney function and proteinuria. To date, no study has evaluated these associations in renal transplant recipients (RTR) adjusting for body adiposity assessed by a ‘gold standard’ method. This study aimed to evaluate the vitamin D status and its association with body adiposity, CVD risk factors, estimated glomerular filtration rate (eGFR) and proteinuria in RTR, living in Rio de Janeiro, Brazil (a low-latitude city (22°54'10"S)), taking into account body adiposity evaluated by dual-energy X-ray absorptiometry (DXA). This cross-sectional study included 195 RTR (114 men) aged 47·6 (sd11·2) years. Nutritional evaluation included anthropometry and DXA. Risk factors for CVD were hypertension, diabetes mellitus, dyslipidaemia and the metabolic syndrome. eGFR was evaluated using the Chronic Kidney Disease Epidemiology Collaboration equation. Serum 25-hydroxyvitamin D (25(OH)D) concentration was used to define vitamin D status as follows: 10 % (n19) had vitamin D deficiency (<16 ng/ml), 43 % (n85) had insufficiency (16–30 ng/ml) and 47 % (n91) had sufficiency (>30 ng/ml). Percentage of body fat (DXA) was significantly associated with vitamin D deficiency independently of age, sex and eGFR. Lower 25(OH)D was associated with higher odds of the metabolic syndrome and dyslipidaemia after adjustment for age, sex and eGFR, but not after additional adjustment for body fat. Hypertension and diabetes were not related to 25(OH)D. Lower serum 25(OH)D was associated with increasing proteinuria and decreasing eGFR even after adjustments for age, sex and percentage of body fat. This study suggests that in RTR of a low-latitude city hypovitaminosis D is common, and is associated with excessive body fat, decreased eGFR and increased proteinuria.
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Park YJ, Kim SU, Lee KH, Lee JH, Kwon E, Jung HY, Choi JY, Cho JH, Park SH, Kim YL, Kim HK, Huh S, Kim CD. Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation. Korean J Intern Med 2017; 32:505-513. [PMID: 27017390 PMCID: PMC5432788 DOI: 10.3904/kjim.2015.214] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/22/2015] [Accepted: 09/09/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. METHODS We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. RESULTS A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. CONCLUSIONS Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.
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Affiliation(s)
- Young-Jae Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang-Un Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kyung-Hee Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Hak Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eugene Kwon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ji-Young Choi
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Correspondence to Chan-Duck Kim, M.D. Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-200-5560 Fax: +82-53-423-7583 E-mail:
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Low levels of 25-hydroxyvitamin D before allogeneic hematopoietic SCT correlate with the development of chronic GVHD. Bone Marrow Transplant 2012; 48:593-7. [DOI: 10.1038/bmt.2012.177] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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9
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Abstract
Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Demographic and lifestyle factors are important in determining D status in transplant recipients. Worse vitamin D status is associated with poorer general health, lower albumin, and even decreased survival among these patients. Although several studies have demonstrated that active forms of vitamin D and its analogues prevent bone loss following transplantation, the data do not show consistent benefit. These therapies may have particular utility after renal transplantation. However, given the narrow therapeutic window with respect to hypercalcemia and hypercalciuria, and the demonstrated efficacy of bisphosphonates to prevent post-transplantation bone loss, we regard these agents as adjunctive rather than primary therapy for transplantation osteoporosis. The effects of 1,25(OH)(2)D on the immune system, which are still being elucidated, may have potential for reducing infections and preventing allograft rejection after transplantation.
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Affiliation(s)
- E M Stein
- Department of Medicine, Columbia University Medical Center, 630 West 168th Street, PH8-864, New York, NY 10032, USA.
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10
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Gueiros APS, Neves CL, Sampaio EDA, Custódio MR. Distúrbio mineral e ósseo após o transplante renal. J Bras Nefrol 2011. [DOI: 10.1590/s0101-28002011000200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Wesseling-Perry K, Tsai EW, Ettenger RB, Jüppner H, Salusky IB. Mineral abnormalities and long-term graft function in pediatric renal transplant recipients: a role for FGF-23? Nephrol Dial Transplant 2011; 26:3779-84. [PMID: 21441401 DOI: 10.1093/ndt/gfr126] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Although current guidelines recommend the evaluation of mineral and bone metabolism in patients with all stages of chronic kidney disease (CKD), the prevalence of altered mineral ion homeostasis in the pediatric posttransplant population is unknown. Moreover, the contribution of abnormal mineral ion metabolism to graft outcomes in this population has not been evaluated. METHODS Serum calcium, phosphorus, 25(OH)vitamin D, 1,25(OH)(2)vitamin D, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) levels were evaluated 4.9 ± 0.5 years after transplantation in 68 stable pediatric renal allograft recipients. Patients were subsequently followed for 2 years. RESULTS At baseline, mean estimated glomerular filtration rate (GFR) was 60 ± 2 mL/min/1.73 m(2). Serum calcium and phosphorus values were within the reference interval. PTH values were elevated but did not differ by CKD stage. 25(OH)vitamin D levels were low in nearly half of all subjects. Tubular reabsorption of phosphate and 1,25(OH)(2)vitamin D values were lower, while FGF-23 and PTH values were higher in more advanced stages of CKD. Thirty percent of patients with FGF-23 values >110 RU/mL had a decrease in GFR of >50% (P < 0.05) and FGF-23 values predicted future episodes of rejection. CONCLUSIONS Despite normal serum calcium and phosphorus levels in the majority of prevalent pediatric renal transplant recipients, abnormalities in PTH, 25(OH)vitamin D and FGF-23 are common. FGF-23 levels may be associated with increased risk for deterioration of kidney function and episodes of rejection.
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Influence of 1,25-Dihydroxyvitamin D3 on Human Leukocyte Antigen-DR Expression, Macrophage Infiltration, and Graft Survival in Renal Allografts. Transplant Proc 2011; 43:500-3. [DOI: 10.1016/j.transproceed.2011.01.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Thiem U, Borchhardt K. Vitamin D in solid organ transplantation with special emphasis on kidney transplantation. VITAMINS AND HORMONES 2011; 86:429-68. [PMID: 21419283 DOI: 10.1016/b978-0-12-386960-9.00019-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Within the past decades, vitamin D was identified as having additional physiological functions far beyond calcium homeostasis and bone metabolism. Stimulated by the discovery of the vitamin D receptor in a broad range of tissues as well as the expression of 1α-hydroxylase, the enzyme responsible for the activation of vitamin D, it became evident that the actions of vitamin D are not restricted to cells involved in mineral and bone metabolism. In fact, it affects proliferation, differentiation, and function of a large number of different cell types including cells of the immune system. Vitamin D receptor agonists were found to exert immunosuppressive effects on the adaptive immune system, thus being able to mediate immunologic tolerance. However, they promote the innate immune system and thereby improve the ability of the host to combat invading pathogens. This review summarizes our current understanding of vitamin D as an immunomodulatory agent with special emphasis on its clinical implications in the transplant setting.
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Affiliation(s)
- Ursula Thiem
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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