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Current evidence on vitamin D deficiency and kidney transplant: What’s new?

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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Acknowledgements

This manuscript was neither prepared nor funded in any part by a commercial organization. We thank William B. Grant, MD, for his kind assistance.

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Correspondence to Gerardo Sarno.

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Sarno, G., Nappi, R., Altieri, B. et al. Current evidence on vitamin D deficiency and kidney transplant: What’s new?. Rev Endocr Metab Disord 18, 323–334 (2017). https://doi.org/10.1007/s11154-017-9418-z

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Keywords

  • Kidney transplantation
  • Vitamin D
  • Kidney graft survival
  • Cardiovascular disease
  • Bone mineral density
  • Malignancies