Introduction and Aims: Native vitamin D (25(OH)D) deficiency is a common finding during kidney transplantation (KTx). The aim of our study is to examine retrospectively in a cohort of kidney transplanted patients the 25(OH)D status and its modification during the first year of KTx Methods: In 290 patients (age 48±11 yrs; M=172) up to the 480 transplanted between 2004 and 2013 in our Department, an evaluation of plasmatic 25(OH)D, clinical parameters, blood and urinary samples at 1st (T1), 6th (T6) and 12th (T12) month of KTx was made. Levels of 25(H)D<20 ng/dL were categorized as insufficient, between 21 and 30 ng/mL as sufficient, >30ng/mL as optimal. The average of the three registration of 25OH(D) was calculated to estimate the level of exposition during the 12 mth of KTx (25(OH)Da). Tertiles of 25(OH)Da were also derived (1st 7.9±1.74 ng/mL; 2nd 12.6±1.27 ng/mL; 3rd 20.3±4.89 ng/mL). The variation on 25(OD)D levels (?-25(??)D) levels was quantified using the formula (T12-T1). Results: 25(OH)D was significantly higher in males (p=0.007) and in patients transplanted during the summer in which remained higher all year long (p=0.0008 vs winter). At T1 and T12, 25(OH)D level was insufficient in 84% and 70% of patients, sufficient in 14% and 23% and optimal in 2% and 7% respectively (p<0.0001). During the first year of KTx a significant increase in 25(OH)D was observed in the patients taken as a whole (T1: 13.2±6.8 - T12: 16.8±9.9 ng/mL- p<0.0001). A treatment with 25(OH)D was present at T1 and T12 in 3% and in 15% of patients (25(OH)Dt+). 25(OH)D was inversely related with time of dialysis at T6 and T12 and an inverse correlation with PTH was present at the three timepoints. A correlation for 25(OH)D with creatinine and eGFR was found only at T6. Also 25OH(D)a was correlated to time of dialysis and PTH, and with Ca at T1 and T6. These results were confirmed also after subdivision of 25(OH)Da in tertiles. In logistic regression winter-KTx and time of dialysis (inversely) and male gender (directly) were related to the affiliation to the 3rd tertile of 25(OH)Da. No effect for immunosuppressive therapy was demonstrated. At T12 in the overall cohort ?-25(??)D was 3.2±9.24 ng/mL, in 23% of patients (9% of them treated with 25OHD), a passage in an higher category of 25(OH)D was observed, whether 8% of patients (4 % of them treated with 25(OH)D) were categorized in a lower category. Interestingly, not significant differences between 25(OH)Dt+ and patient non treated with 25(OH)D both in ?-25(??)D and in change of 25(OH)D category were demonstrated. Conclusions: According to our results, the prevalence of native hypovitaminosis D in KTx patients is high, especially at the beginning of KTx. KTx performed during winter, the time of dialysis and female gender influence negatively 25(OH)D levels. The treatment typically used was not sufficient in correct vitamin D deficit.
EVALUATION OF VITAMIN D STATUS DURING KIDNEY TRANSPLANTATION: FACTORS RELATED AND EFFECT OF THE TREATMENT
Fusaro Maria;
2016
Abstract
Introduction and Aims: Native vitamin D (25(OH)D) deficiency is a common finding during kidney transplantation (KTx). The aim of our study is to examine retrospectively in a cohort of kidney transplanted patients the 25(OH)D status and its modification during the first year of KTx Methods: In 290 patients (age 48±11 yrs; M=172) up to the 480 transplanted between 2004 and 2013 in our Department, an evaluation of plasmatic 25(OH)D, clinical parameters, blood and urinary samples at 1st (T1), 6th (T6) and 12th (T12) month of KTx was made. Levels of 25(H)D<20 ng/dL were categorized as insufficient, between 21 and 30 ng/mL as sufficient, >30ng/mL as optimal. The average of the three registration of 25OH(D) was calculated to estimate the level of exposition during the 12 mth of KTx (25(OH)Da). Tertiles of 25(OH)Da were also derived (1st 7.9±1.74 ng/mL; 2nd 12.6±1.27 ng/mL; 3rd 20.3±4.89 ng/mL). The variation on 25(OD)D levels (?-25(??)D) levels was quantified using the formula (T12-T1). Results: 25(OH)D was significantly higher in males (p=0.007) and in patients transplanted during the summer in which remained higher all year long (p=0.0008 vs winter). At T1 and T12, 25(OH)D level was insufficient in 84% and 70% of patients, sufficient in 14% and 23% and optimal in 2% and 7% respectively (p<0.0001). During the first year of KTx a significant increase in 25(OH)D was observed in the patients taken as a whole (T1: 13.2±6.8 - T12: 16.8±9.9 ng/mL- p<0.0001). A treatment with 25(OH)D was present at T1 and T12 in 3% and in 15% of patients (25(OH)Dt+). 25(OH)D was inversely related with time of dialysis at T6 and T12 and an inverse correlation with PTH was present at the three timepoints. A correlation for 25(OH)D with creatinine and eGFR was found only at T6. Also 25OH(D)a was correlated to time of dialysis and PTH, and with Ca at T1 and T6. These results were confirmed also after subdivision of 25(OH)Da in tertiles. In logistic regression winter-KTx and time of dialysis (inversely) and male gender (directly) were related to the affiliation to the 3rd tertile of 25(OH)Da. No effect for immunosuppressive therapy was demonstrated. At T12 in the overall cohort ?-25(??)D was 3.2±9.24 ng/mL, in 23% of patients (9% of them treated with 25OHD), a passage in an higher category of 25(OH)D was observed, whether 8% of patients (4 % of them treated with 25(OH)D) were categorized in a lower category. Interestingly, not significant differences between 25(OH)Dt+ and patient non treated with 25(OH)D both in ?-25(??)D and in change of 25(OH)D category were demonstrated. Conclusions: According to our results, the prevalence of native hypovitaminosis D in KTx patients is high, especially at the beginning of KTx. KTx performed during winter, the time of dialysis and female gender influence negatively 25(OH)D levels. The treatment typically used was not sufficient in correct vitamin D deficit.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
