25(OH)D-but not 1,25(OH)2D-Is an independent risk factor predicting graft loss in stable kidney transplant recipients

Shufei Zeng; Yide Yang; Shuping Li; Carl-Friedrich Hocher; Chang Chu; Ziqiang Wang; Zhihua Zheng; Bernhard K Krämer; Berthold Hocher

doi:10.3389/fmed.2023.1141646

25(OH)D-but not 1,25(OH)₂D-Is an independent risk factor predicting graft loss in stable kidney transplant recipients

Front Med (Lausanne). 2023 Apr 20:10:1141646. doi: 10.3389/fmed.2023.1141646. eCollection 2023.

Authors

Shufei Zeng^#¹, Yide Yang^#², Shuping Li³, Carl-Friedrich Hocher^{4

5}, Chang Chu⁴, Ziqiang Wang⁶, Zhihua Zheng³, Bernhard K Krämer^{4

7}, Berthold Hocher^{4

8

9

10}

Affiliations

¹ Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Key Laboratory of Molecular Epidemiology of Hunan Province, Changsha, China.
³ Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
⁴ Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumonology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany.
⁵ Klinik für Innere Medizin, Bundeswehrkrankenhaus Berlin, Berlin, Germany.
⁶ Department of Nephrology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
⁷ European Center for Angioscience (ECAS), Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
⁸ Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.
⁹ Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China.
¹⁰ Institute of Medical Diagnostics, IMD, Berlin, Germany.

^# Contributed equally.

Abstract

Background: Vitamin D deficiency (VDD) or vitamin D insufficiency is common in kidney transplant recipients (KTRs). The impact of VDD on clinical outcomes in KTRs remain poorly defined and the most suitable marker for assessing vitamin D nutritional status in KTRs is unknown so far.

Methods: We conducted a prospective study including 600 stable KTRs (367 men, 233 women) and a meta-analysis to pool existing evidence to determine whether 25(OH)D or 1,25(OH)₂D predicted graft failure and all-cause mortality in stable KTRs.

Results: Compared with a higher 25(OH)D concentration, a low concentration of 25(OH)D was a risk factor for graft failure (HR 0.946, 95% CI 0.912-0.981, p = 0.003), whereas 1,25 (OH)₂D was not associated with the study end-point graft loss (HR 0.993, 95% CI 0.977-1.009, p = 0.402). No association was found between either 25(OH)D or 1,25 (OH)₂D and all-cause mortality. We furthermore conducted a meta-analysis including 8 studies regarding the association between 25(OH)D or 1,25(OH)₂D and graft failure or mortality, including our study. The meta-analysis results were consistent with our study in finding that lower 25(OH)D levels were significantly associated with the risk of graft failure (OR = 1.04, 95% CI: 1.01-1.07), but not associated with mortality (OR = 1.00, 95% CI: 0.98-1.03). Lower 1,25(OH)₂D levels were not associated with the risk of graft failure (OR = 1.01, 95% CI: 0.99-1.02) and mortality (OR = 1.01, 95% CI: 0.99-1.02).

Conclusion: Baseline 25(OH)D concentrations but not 1,25(OH)₂D concentrations were independently and inversely associated with graft loss in adult KTRs.

Keywords: 1; 25(OH)2D; 25(OH)D; all-cause mortality; graft loss; kidney transplantation.

Grants and funding

This research was supported by the Hainan Provincial Natural Science Foundation of China (821QN406).