Associations of 25(OH) and 1,25(OH)(2) Vitamin D With Long-Term Outcomes in Stable Renal Transplant Recipients

Charlotte A. Keyzer; Ineke J. Riphagen; Michel M. Joosten; Gerjan Navis; Anna C.  Muller Kobold; Ido P. Kema; Stephan J. L. Bakker; Martin H. de Borst; NIGRAM Consortium

doi:10.1210/jc.2014-3012

Associations of 25(OH) and 1,25(OH)(2) Vitamin D With Long-Term Outcomes in Stable Renal Transplant Recipients

Charlotte A. Keyzer, Ineke J. Riphagen, Michel M. Joosten, Gerjan Navis, Anna C. Muller Kobold, Ido P. Kema, Stephan J. L. Bakker, Martin H. de Borst^*, NIGRAM Consortium

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

61 Citations (Scopus)

Abstract

Context: Vitamin D deficiency is common in renal transplant recipients (RTR). The long-term implications of vitamin D deficiency in RTR remain unclear.

Objective: We investigated whether 25(OH) or 1,25(OH)(2) vitamin D levels are associated with mortality, renal function decline, and graft failure in stable RTR.

Design: Observational study with longitudinal design. Followup was 7.0, interquartile range (IQR) 6.2-7.5 years.

Setting: Single-center outpatient clinic.

Participants: 435 stable RTR (51% men, mean age 52 +/- 12 years) were included at a median [IQR] of 6 [3-12] years after kidney transplantation.

Main Outcome Measures: All-cause mortality, annual change of estimated glomerular filtration rate (eGFR), and graft failure.

Results: Mean 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were 21.6 +/- 9.1 ng/ml and 45.2 +/- 19.0 pg/ml, respectively. During followup, 99 patients (22.8%) died and 44 patients (10.1%) developed graft failure. In univariable analysis, both 25(OH)D and 1,25(OH)(2)D were significantly associated with mortality (hazard ratio [HR], 0.64; 95% confidence interval (CI), 0.51-0.81; P <.001 and HR 0.69 [95% CI, 0.55-0.87], P = .002 per SD increase, respectively). The inverse association of 25(OH)D with mortality remained significant after adjustment for potential confounders (HR 0.68 [95% CI, 0.52-0.89], P = .004 per SD increase). The associations of 1,25(OH)(2)D with mortality and graft failure lost significance after adjustment for renal function. Severe vitamin D deficiency (25[OH]D

Conclusions: Low 25(OH) D is independently associated with an increased risk of all-cause mortality and 25(OH) D <12 ng/ml with a rapid eGFR decline in stable RTR. The association of low 1,25(OH)(2)D with mortality or graft failure depends on renal function. These results should encourage randomised controlled trials evaluating the effect of vitamin D supplementation after kidney transplantation.

Original language	English
Pages (from-to)	81-89
Number of pages	9
Journal	Journal of Clinical Endocrinology and Metabolism
Volume	100
Issue number	1
DOIs	https://doi.org/10.1210/jc.2014-3012
Publication status	Published - Jan-2015

Keywords

CHRONIC KIDNEY-DISEASE
C-REACTIVE PROTEIN
CARDIOVASCULAR-DISEASE
D DEFICIENCY
CIRCULATING MARKERS
ALLOGRAFT FUNCTION
METABOLIC SYNDROME
D SUPPLEMENTATION
MORTALITY
RISK

Access to Document

10.1210/jc.2014-3012

Handle.net

Persistent link

Embargoed Document

Associations of 25(OH) and 1,25(OH)(2) Vitamin D With Long-Term Outcomes
Final publisher's version, 520 KB
Request copy

TransplantLines
Bakker, S. (Creator), Leuvenink, H. G. D. (Creator) & Porte, R. J. (Creator), University of Groningen, 2017
http://www.transplantlines.umcg.nl
Dataset

Kolff Junior Postdoc grant; “Vitamin D: the key to regression of renal fibrosis?” (KJPB.08.07)
Borst, de, M. (Recipient), 2008
Prize: Fellowship awarded competitively › Academic

Cite this

Keyzer, C. A., Riphagen, I. J., Joosten, M. M., Navis, G., Muller Kobold, A. C., Kema, I. P., Bakker, S. J. L., de Borst, M. H., & NIGRAM Consortium (2015). Associations of 25(OH) and 1,25(OH)(2) Vitamin D With Long-Term Outcomes in Stable Renal Transplant Recipients. Journal of Clinical Endocrinology and Metabolism, 100(1), 81-89. https://doi.org/10.1210/jc.2014-3012

@article{d99ca0c546b84424bfc6f44a2288e015,

title = "Associations of 25(OH) and 1,25(OH)(2) Vitamin D With Long-Term Outcomes in Stable Renal Transplant Recipients",

abstract = "Context: Vitamin D deficiency is common in renal transplant recipients (RTR). The long-term implications of vitamin D deficiency in RTR remain unclear.Objective: We investigated whether 25(OH) or 1,25(OH)(2) vitamin D levels are associated with mortality, renal function decline, and graft failure in stable RTR.Design: Observational study with longitudinal design. Followup was 7.0, interquartile range (IQR) 6.2-7.5 years.Setting: Single-center outpatient clinic.Participants: 435 stable RTR (51% men, mean age 52 +/- 12 years) were included at a median [IQR] of 6 [3-12] years after kidney transplantation.Main Outcome Measures: All-cause mortality, annual change of estimated glomerular filtration rate (eGFR), and graft failure.Results: Mean 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were 21.6 +/- 9.1 ng/ml and 45.2 +/- 19.0 pg/ml, respectively. During followup, 99 patients (22.8%) died and 44 patients (10.1%) developed graft failure. In univariable analysis, both 25(OH)D and 1,25(OH)(2)D were significantly associated with mortality (hazard ratio [HR], 0.64; 95% confidence interval (CI), 0.51-0.81; P <.001 and HR 0.69 [95% CI, 0.55-0.87], P = .002 per SD increase, respectively). The inverse association of 25(OH)D with mortality remained significant after adjustment for potential confounders (HR 0.68 [95% CI, 0.52-0.89], P = .004 per SD increase). The associations of 1,25(OH)(2)D with mortality and graft failure lost significance after adjustment for renal function. Severe vitamin D deficiency (25[OH]DConclusions: Low 25(OH) D is independently associated with an increased risk of all-cause mortality and 25(OH) D <12 ng/ml with a rapid eGFR decline in stable RTR. The association of low 1,25(OH)(2)D with mortality or graft failure depends on renal function. These results should encourage randomised controlled trials evaluating the effect of vitamin D supplementation after kidney transplantation.",

keywords = "CHRONIC KIDNEY-DISEASE, C-REACTIVE PROTEIN, CARDIOVASCULAR-DISEASE, D DEFICIENCY, CIRCULATING MARKERS, ALLOGRAFT FUNCTION, METABOLIC SYNDROME, D SUPPLEMENTATION, MORTALITY, RISK",

author = "Keyzer, {Charlotte A.} and Riphagen, {Ineke J.} and Joosten, {Michel M.} and Gerjan Navis and {Muller Kobold}, {Anna C.} and Kema, {Ido P.} and Bakker, {Stephan J. L.} and {de Borst}, {Martin H.} and {NIGRAM Consortium}",

year = "2015",

month = jan,

doi = "10.1210/jc.2014-3012",

language = "English",

volume = "100",

pages = "81--89",

journal = "Journal of Clinical Endocrinology and Metabolism",

issn = "0021-972X",

publisher = "Oxford University Press",

number = "1",

}

TY - JOUR

T1 - Associations of 25(OH) and 1,25(OH)(2) Vitamin D With Long-Term Outcomes in Stable Renal Transplant Recipients

AU - Keyzer, Charlotte A.

AU - Riphagen, Ineke J.

AU - Joosten, Michel M.

AU - Navis, Gerjan

AU - Muller Kobold, Anna C.

AU - Kema, Ido P.

AU - Bakker, Stephan J. L.

AU - de Borst, Martin H.

AU - NIGRAM Consortium

PY - 2015/1

Y1 - 2015/1

N2 - Context: Vitamin D deficiency is common in renal transplant recipients (RTR). The long-term implications of vitamin D deficiency in RTR remain unclear.Objective: We investigated whether 25(OH) or 1,25(OH)(2) vitamin D levels are associated with mortality, renal function decline, and graft failure in stable RTR.Design: Observational study with longitudinal design. Followup was 7.0, interquartile range (IQR) 6.2-7.5 years.Setting: Single-center outpatient clinic.Participants: 435 stable RTR (51% men, mean age 52 +/- 12 years) were included at a median [IQR] of 6 [3-12] years after kidney transplantation.Main Outcome Measures: All-cause mortality, annual change of estimated glomerular filtration rate (eGFR), and graft failure.Results: Mean 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were 21.6 +/- 9.1 ng/ml and 45.2 +/- 19.0 pg/ml, respectively. During followup, 99 patients (22.8%) died and 44 patients (10.1%) developed graft failure. In univariable analysis, both 25(OH)D and 1,25(OH)(2)D were significantly associated with mortality (hazard ratio [HR], 0.64; 95% confidence interval (CI), 0.51-0.81; P <.001 and HR 0.69 [95% CI, 0.55-0.87], P = .002 per SD increase, respectively). The inverse association of 25(OH)D with mortality remained significant after adjustment for potential confounders (HR 0.68 [95% CI, 0.52-0.89], P = .004 per SD increase). The associations of 1,25(OH)(2)D with mortality and graft failure lost significance after adjustment for renal function. Severe vitamin D deficiency (25[OH]DConclusions: Low 25(OH) D is independently associated with an increased risk of all-cause mortality and 25(OH) D <12 ng/ml with a rapid eGFR decline in stable RTR. The association of low 1,25(OH)(2)D with mortality or graft failure depends on renal function. These results should encourage randomised controlled trials evaluating the effect of vitamin D supplementation after kidney transplantation.

AB - Context: Vitamin D deficiency is common in renal transplant recipients (RTR). The long-term implications of vitamin D deficiency in RTR remain unclear.Objective: We investigated whether 25(OH) or 1,25(OH)(2) vitamin D levels are associated with mortality, renal function decline, and graft failure in stable RTR.Design: Observational study with longitudinal design. Followup was 7.0, interquartile range (IQR) 6.2-7.5 years.Setting: Single-center outpatient clinic.Participants: 435 stable RTR (51% men, mean age 52 +/- 12 years) were included at a median [IQR] of 6 [3-12] years after kidney transplantation.Main Outcome Measures: All-cause mortality, annual change of estimated glomerular filtration rate (eGFR), and graft failure.Results: Mean 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were 21.6 +/- 9.1 ng/ml and 45.2 +/- 19.0 pg/ml, respectively. During followup, 99 patients (22.8%) died and 44 patients (10.1%) developed graft failure. In univariable analysis, both 25(OH)D and 1,25(OH)(2)D were significantly associated with mortality (hazard ratio [HR], 0.64; 95% confidence interval (CI), 0.51-0.81; P <.001 and HR 0.69 [95% CI, 0.55-0.87], P = .002 per SD increase, respectively). The inverse association of 25(OH)D with mortality remained significant after adjustment for potential confounders (HR 0.68 [95% CI, 0.52-0.89], P = .004 per SD increase). The associations of 1,25(OH)(2)D with mortality and graft failure lost significance after adjustment for renal function. Severe vitamin D deficiency (25[OH]DConclusions: Low 25(OH) D is independently associated with an increased risk of all-cause mortality and 25(OH) D <12 ng/ml with a rapid eGFR decline in stable RTR. The association of low 1,25(OH)(2)D with mortality or graft failure depends on renal function. These results should encourage randomised controlled trials evaluating the effect of vitamin D supplementation after kidney transplantation.

KW - CHRONIC KIDNEY-DISEASE

KW - C-REACTIVE PROTEIN

KW - CARDIOVASCULAR-DISEASE

KW - D DEFICIENCY

KW - CIRCULATING MARKERS

KW - ALLOGRAFT FUNCTION

KW - METABOLIC SYNDROME

KW - D SUPPLEMENTATION

KW - MORTALITY

KW - RISK

U2 - 10.1210/jc.2014-3012

DO - 10.1210/jc.2014-3012

M3 - Article

C2 - 25361179

SN - 0021-972X

VL - 100

SP - 81

EP - 89

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

IS - 1

ER -

Associations of 25(OH) and 1,25(OH)(2) Vitamin D With Long-Term Outcomes in Stable Renal Transplant Recipients

Abstract

Keywords

Access to Document

Handle.net

Embargoed Document

Fingerprint

Datasets

TransplantLines

Prizes

Kolff Junior Postdoc grant; “Vitamin D: the key to regression of renal fibrosis?” (KJPB.08.07)

Cite this