Abstract
PurposeCKD patients after kidney transplantation continue to suffer from elevated CV events which may be related to low vitamin D and its adverse impact on vascular function. The prevalence of vitamin D deficiency in North Indian kidney transplantation patients and its impact on vascular and bone biomarkers is unknown which this study investigated.MethodsNon-diabetic, stable, > 6 months post-kidney transplantation patients, not on vitamin D supplementation, were recruited after informed consent. Data on demographics, anthropometrics and treatment were collected. Blood samples were stored at − 80 °C until analysis for bone and endothelial cell biomarkers using standard ELISA techniques.ResultsThe clinical characteristics were: age 37.4 ± 9.9 years, 80% men, 27% ex-smokers, BP 125.5 ± 15.7/78.6 ± 9.7 mmHg, cholesterol 172.0 ± 47.8 mg/dL, hemoglobin 12.6 ± 2.3 g/dL, calcium 9.5 ± 0.6 mg/d and iPTH 58.4 ± 32.9 ng/mL and vitamin D 36.5 ± 39.8 nmol/L. Patients with vitamin D < 37.5 nmol/L (66%) had similar age, serum creatinine, serum phosphate, iPTH, blood pressure but lower calcium (9.3 ± 0.7 vs. 9.6 ± 0.5 mg/dL; p = 0.024), lower FGF23 (median 18.8 vs. 80.0 pg/mL; p = 0.013) and higher E-selectin (15.8 ± 7.9 vs. 13.0 ± 5.5 ng/mL; p = 0.047). On Univariate analysis, E-selectin (r = − 0.292; p = 0.005), FGF23 (r = 0.217; p = 0.036) and calcium (r = 0.238; p = 0.022) were significantly correlated with vitamin D levels. On stepwise multiple regression analysis, only E-selectin was associated with vitamin D levels (β = − 0.324; p = 0.002).ConclusionVitamin D deficiency was common in kidney transplant recipients in North India, associated with low FGF23 and high E-selectin. These findings suggest further investigations to assess the role of vitamin D deficiency-associated endothelial dysfunction, its implications and reversibility in kidney transplantation recipients.
Highlights
The high mortality due to cardiovascular events in chronic kidney disease (CKD) patients is not fully explained by traditional risk factors, leading to exploration of the contribution of non-traditional risk factors such as vitamin D deficiency
Renal dysfunction is associated with endothelial dysfunction, which is a cause of premature atherosclerosis in the patients with CKD [1, 15]
Vitamin D and Fibroblast growth factor (FGF)-23 levels were compared between patients with normal and abnormal endothelial functions
Summary
The high mortality due to cardiovascular events in chronic kidney disease (CKD) patients is not fully explained by traditional risk factors, leading to exploration of the contribution of non-traditional risk factors such as vitamin D deficiency. Vitamin D deficiency has been associated with endothelial dysfunction [1] and atherosclerosis in general population and in subjects with CKD [2, 3]. Cardiovascular events are the commonest cause of mortality post-kidney transplantation, fifty-fold higher than general population [4]. FGF23 reduces vitamin D synthesis and increases serum PTH [7]. Serum FGF23 level is increased in hemodialysis patients and is associated with mortality [8]. High FGF23 is associated with cardiovascular mortality
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