Background: Vitamin D deficiency in KTRs is an emerging theme. The purported associations between Vitamin D deficiency and various metabolic, cardiovascular and non-metabolic adverse events have not been thoroughly studied in kidney transplant recipients (KTRs).

Methods: Here, we examined the association between Vitamin D deficiency and graft loss, mortality, NODAT, cardiovascular events and development of cancers.

Results: 504 KTRs had their vitamin D checked in 2008 and were followed up for 6 years. Vitamin D deficiency was defined as a level<50nmol/L. In this population, the prevalence of vitamin D deficiency was high at 66.5% with a significantly higher prevalence in older (71.9% vs. 60.9%, P=0.006) and female recipients (male 62.1% vs. female 73.2%, P=0.006) and in relatively new transplants (recent transplants 72.3% vs. old transplants 60.6%, P=0.003). KTRs who were vitamin D deficient had significantly worse overall (77% vs. 92%, P<0.0001), death censored graft survival (89% vs. 96%, P=0.009), development of NODAT (19.8% vs. 10% p=0.005) and cardiovascular events (9.9% VS. 2.9%, p=0.002) when compared to those with normal levels. In a stratified analysis, this was noted to be worse in KTRs on maintenance steroids, with relatively worse baseline renal function and proteinuria, with secondary hyperparathyroidism, deceased donor transplants and earlier vs. late transplants. Although vitamin D deficiency is not associated with a higher incidence of malignancy, it is associated with higher mortality in those with cancer (33.3% VS. 12.9%, p=0.005). In a multivariate Cox model, vitamin D deficiency was associated with significantly worse overall graft (HR 2.7, P=0.001) and death censored graft survival (HR 2.4, P=0.04), NODAT (HR 2.3, p=0.03) and cardiovascular events (HR 4.0, P=0.004) independent of age, PTH levels, gender, graft number, type of transplant, time since transplantation, graft type and renal function measured by both proteinuria and eGFR.

Conclusions: In conclusion, vitamin D deficiency which is highly prevalent in KTRs is associated with adverse clinical outcomes. Our study stresses the need for a prospective trial of vitamin D replacement in KTRs.

CITATION INFORMATION: Cherukuri A, Balasubramanian S, Molyneux R, Baker R. Beyond the Bones – The Association Between Vitamin D, Graft Outcomes and Vascular Disease. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress