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Vitamin D status in kidney transplant patients: need for intensified routine supplementation^1,2,3

¹ From the Department of Nephrology, Copenhagen University Hospital Herlev, Herlev, Denmark (BE, AG, AMF, and PM), and the Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark (CM)

Background: A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease.

Objective: The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish kidney transplant patients.

Design: This was a cross-sectional study of 173 adult kidney transplant patients with a mean (±SD) age of 53.4 ± 11.7 y and a median graft age of 7.4 y (interquartile range: 3.3–12.7 y). Serum concentrations of intact parathyroid hormone (S-PTH), 25-hydroxyvitamin D [S-25(OH)D], and 1,25-dihydroxyvitamin D [S-1,25(OH)₂D] were measured. Dietary and supplementary intake of vitamin D, avoidance of solar ultraviolet B exposure, and selected lifestyle factors were assessed in a subgroup (n = 97).

Results: Fifty-one percent of the patients had vitamin D insufficiency [S-25(OH)D 40–75 nmol/L], and an additional 29% had moderate-to-severe vitamin D deficiency [S-25(OH)D 39 nmol/L]. In multiple regression analysis, sun avoidance (negative association) and vitamin D supplementation (positive association) were independent determinants of S-25(OH)D concentrations. Low S-25(OH)D concentrations were associated with 1) increased S-PTH concentrations (P = 0.0002), independently of S-1,25(OH)₂D concentrations, and 2) decreased S-1,25(OH)₂D concentrations (P = 0.002), independently of graft function.

Conclusions: Hypovitaminosis D is common among Danish kidney transplant patients and is associated with reduced concentrations of S-1,25(OH)₂D and increased S-PTH concentrations. Sun avoidance and vitamin D supplementation are important determinants of vitamin D status. The observed hypovitaminosis D might be corrected by intensified routine vitamin D supplementation as opposed to the current supplementation practice.

Key Words: Kidney transplantation • hypovitaminosis D • prevalence • sun exposure • vitamin D intake • 25-hydroxyvitamin D • 1,25-dihydroxyvitamin D • parathyroid hormone