Yoshitsugu Obi1, Takayuki Hamano, Naotsugu Ichimaru, Kodo Tomida, Isao Matsui, Naohiko Fujii, Masayoshi Okumi, Jun-ya Kaimori, Koji Yazawa, Yukito Kokado, Norio Nonomura, Hiromi Rakugi, Shiro Takahara, Yoshitaka Isaka, Yoshiharu Tsubakihara. 1. Departments of Geriatric Medicine and Nephrology (Y.O., I.M., H.R., Y.I.), Comprehensive Kidney Disease Research (T.H., Y.T.), Advanced Technology for Transplantation (N.I., J.K., S.T.), and Specific Organ Regulation (Urology) (M.O., K.Y., N.N.), Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan; Department of Kidney Disease and Hypertension (K.T.), Osaka General Medical Center, Osaka 558-0056, Osaka, Japan; Department of Internal Medicine (N.F.), Hyogo Prefectural Nishinomiya Hospital, Nishinomiya 662-0918, Hyogo, Japan; and Takahashi Clinic (Y.K.), Toyonaka 570-0027, Osaka, Japan.
Abstract
CONTEXT: Vitamin D, often deficient in kidney transplant (KTx) recipients, has potential immunomodulatory effects. OBJECTIVE: This study aimed to evaluate whether vitamin D status affects the rate of decline in kidney allograft function. DESIGN, SETTING, AND PATIENTS: The study included a prospective cohort of 264 ambulatory KTx recipients at a single Japanese center. MAIN OUTCOME MEASURES: We measured the baseline 25-hydroxyvitamin D (25D) concentration and examined its association with annual decline in estimated glomerular filtration rate (eGFR). Secondary outcome was rescue treatment with iv methylprednisolone (IV-MP) as an index of rejection episodes. RESULTS: The mean serum 25D concentration was 17.1 (SD 6.5) ng/mL, and 68.4% patients had vitamin D inadequacy or deficiency. Time after KTx was a significant effect modifier for the association of serum 25D concentration with annual eGFR change and need for IV-MP (P for interaction < .1). We divided patients according to the median time after KTx (10 y) and found that low vitamin D was significantly associated with a rapid eGFR decline at less than 10 years after KTx but not at 10 or more years after KTx. The same was true for rescue treatment with IV-MP. Overall, propensity score matching showed independent associations of low vitamin D with both outcomes. Stratified matching confirmed pronounced associations at less than 10 years after KTx. CONCLUSIONS: 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.
CONTEXT: Vitamin D, often deficient in kidney transplant (KTx) recipients, has potential immunomodulatory effects. OBJECTIVE: This study aimed to evaluate whether vitamin D status affects the rate of decline in kidney allograft function. DESIGN, SETTING, AND PATIENTS: The study included a prospective cohort of 264 ambulatory KTx recipients at a single Japanese center. MAIN OUTCOME MEASURES: We measured the baseline 25-hydroxyvitamin D (25D) concentration and examined its association with annual decline in estimated glomerular filtration rate (eGFR). Secondary outcome was rescue treatment with iv methylprednisolone (IV-MP) as an index of rejection episodes. RESULTS: The mean serum 25D concentration was 17.1 (SD 6.5) ng/mL, and 68.4% patients had vitamin D inadequacy or deficiency. Time after KTx was a significant effect modifier for the association of serum 25D concentration with annual eGFR change and need for IV-MP (P for interaction < .1). We divided patients according to the median time after KTx (10 y) and found that low vitamin D was significantly associated with a rapid eGFR decline at less than 10 years after KTx but not at 10 or more years after KTx. The same was true for rescue treatment with IV-MP. Overall, propensity score matching showed independent associations of low vitamin D with both outcomes. Stratified matching confirmed pronounced associations at less than 10 years after KTx. CONCLUSIONS: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.
Authors: Luigi Francesco Morrone; Pergiorgio Bolasco; Corrado Camerini; Giuseppe Cianciolo; Adamasco Cupisti; Andrea Galassi; Sandro Mazzaferro; Domenico Russo; Luigi Russo; Mario Cozzolino Journal: J Nephrol Date: 2016-04-09 Impact factor: 3.902
Authors: Cristiane F Vilarta; Marianna D Unger; Luciene M Dos Reis; Wagner V Dominguez; Elias David-Neto; Rosa M Moysés; Silvia Titan; Melani R Custodio; Mariel J Hernandez; Vanda Jorgetti Journal: Clinics (Sao Paulo) Date: 2017-07 Impact factor: 2.365