• bone density
• calcitriol
• osteoporosis
• transplant
• trial

• Humans
• Kidney Transplantation
• Calcitriol/pharmacology
• Calcitriol/administration & dosage
• Calcitriol/adverse effects
• Calcitriol/therapeutic use
• Male
• Female
• Double-Blind Method
• Middle Aged
• Adult
• Bone Density/drug effects
• Dietary Supplements
• Placebos
• Aged

• T35 DK093430 NIDDK NIH HHS
• 5T35DK093430 Columbia University Vagelos College of Physicians and Surgeons
• 498-2023 EMBO Postdoctoral Fellowship
• NIH National Institute of Diabetes and Digestive and Kidney Diseases

• diet post transplant
• graft survival
• kideny transplantation
• nutrition guidelines
• post kidney transplant care

• Humans
• Kidney Transplantation
• Graft Survival
• Reperfusion Injury/prevention & control
• Diet
• Oxidative Stress

• calcineurin inhibitor
• chronic kidney disease
• classification and regression trees
• cyclosporin A
• data mining
• vitamin D

• 2011/03/B/NZ7/06550 National Science Center of Poland

Vitamin D deficiency occurs in more than 80% of kidney transplant recipients. Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy (CAN). This study determined the association between serum 25 (OH) vitamin D, biopsy-proven allograft rejection, and CAN rates.

To determine the relationship between serum 25 (OH) vitamin D level and biopsy-proven allograft rejection and CAN rate in renal transplant recipients.

Adult renal transplant recipients followed at the clinic between January 2013 and 2018 were included. Recipients requiring graft biopsy due to declined function, hematuria, and proteinuria were reviewed. The two groups were compared regarding collected data, including the biopsy results, immunologic parameters, vitamin D, parathyroid hormone (PTH), phosphorus, albumin levels, and graft function tests.

Fifty-two recipients who underwent graft biopsy met the inclusion criteria. In all, 14 recipients had a vitamin D level > 15 ng/mL (group 1) vs ≤ 15 ng/mL (group 2) in 38. In total, 27 patients had biopsy-proven rejection, and 19 had CAN. There was only 1 recipient with biopsy-proven rejection in group 1, whereas there were 24 patients with rejection in group 2. The rejection rate was significantly higher in group 2 than in group 1 (P < 0.001). Four patients were diagnosed with CAN in group 1 vs fifteen in group 2. There was no significant difference in the CAN rate between the two groups. PTH was higher at the time of graft biopsy (P = 0.009, P = 0.022) in group 1 with a mean of 268 pg/mL. Donor-specific antibodies were detected in 14 (56.0%) of the recipients with rejection. Vitamin D level was 9.7 ± 3.4 ng/mL in the rejection group vs 14.7 ± 7.2 in the non-rejection group; this difference was statistically significant (P = 0.003). The albumin levels were significantly lower in patients with rejection than in those without rejection (P = 0.001). In univariate regression analysis of risk factors affecting rejection, sex, serum vitamin D, phosphorus and albumin were found to have an impact (P = 0.027, P = 0.007, P = 0.023, P = 0.008). In multivariate regression analysis, the same factors did not affect rejection.

The serum 25 (OH) vitamin D level in kidney transplant recipients remained low. Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis, this finding was not confirmed by multivariate analysis. Prospective studies are required to determine the effect of serum vitamin D levels on allograft rejection.

• Kidney transplantation
• Rejection
• 25 (OH) vitamin D
• Vitamin D
• Chronic allograft nephropathy

Background and Aims: The purpose of this study was to identify the characteristics and risk factors for cardiovascular calcification, and its relationship to prognosis, in patients with chronic kidney disease (CKD) stages 1–4.

Methods: Cardiovascular calcification was evaluated at baseline by lateral abdominal radiography to detect abdominal aortic calcifications (AAC), and by echocardiogram to detect cardiac valvular calcifications (CVC), respectively. Demographic and laboratory data were collected and analyzed. Univariate and multivariable logistic regression model was used to explore the factors associated with the indicators of cardiovascular calcification, while Cox proportional hazards regression was used to examine the association between AAC/CVC and incidence of cardiovascular events and all-cause mortality.

Results: A subgroup of 2,235 patients with measurement of AAC in the C-STRIDE study and a subgroup of 2,756 patients with CVC were included in the analysis. AAC was present in 206 patients (9.22%) and CVC was present in 163 patients (5.91%). Age, gender, history of cardiovascular diseases, smoking, hypertension, diabetes, levels of hemoglobin, low-density lipoprotein cholesterol, and uric acid were associated with prevalence of AAC, while only age, history of cardiovascular diseases, levels of serum albumin and low-density lipoprotein cholesterol were associated with prevalence of CVC (all p < 0.05).Survival analyses showed that cardiovascular events and all-cause mortality were significantly greater in patients with AACor with CVC (all p-values for log-rank tests <0.05). After adjustment for age, sex and estimated glomerular filtration rate (eGFR), AAC was associated with increased risk of all-cause mortality (hazard ratio = 1.67[95% confidence interval: 0.99, 2.79]), while CVC associated with that of cardiovascular events only among patients with comparatively normal eGFR (≥45 ml/min/1.73m²) (hazard ratio = 1.99 [0.98, 4.03]).

Conclusion: Demographic and traditional cardiovascular risk factors were associated with cardiovascular calcification, especially AAC. AAC may be associated with risk of death for patients CKD of any severity, while CVC as a possible risk factor for cardiovascular disease only among those with mild to moderate CKD. Assessments of vascular calcification are need to be advanced to patients in the early and middle stages of chronic kidney disease and to initiate appropriate preventive measures earlier.

• C-STRIDE
• abdominal aortic calcification
• cardiac valve calcification
• cardiovascular calcification
• chronic kidney disease

• kidney transplantation series
• mineral metabolism

• Chronic Kidney Disease-Mineral and Bone Disorder/diagnosis
• Chronic Kidney Disease-Mineral and Bone Disorder/etiology
• Chronic Kidney Disease-Mineral and Bone Disorder/therapy
• Humans
• Kidney Transplantation
• Postoperative Complications/diagnosis
• Postoperative Complications/etiology
• Postoperative Complications/therapy

• Adoptively transfer
• Immunoregulation
• Monoclonal antibodies
• T cell biology
• Transplantation
• Vitamin D3

• dual-energy X-ray absorptiometry scan
• melanoma
• sun avoidance
• trabecular bone score
• vitamin D

• Calcitriol
• Cancer protection
• Organ transplant recipients
• Skin cancer
• Solar UV exposure
• UV protection
• Vitamin D deficiency
• Vitamin D supplementation

• cholecalciferol
• chronic kidney disease
• kidney transplant
• parathyroid hormone
• secondary hyperparathyroidism

• Adult
• Calcium/blood
• Calcium/metabolism
• Calcium/urine
• Calcium-Regulating Hormones and Agents/administration & dosage
• Cholecalciferol/administration & dosage
• Cohort Studies
• Creatinine/blood
• Creatinine/metabolism
• Creatinine/urine
• Female
• Glomerular Filtration Rate
• Humans
• Kidney
• Kidney Transplantation/methods
• Male
• Middle Aged
• Parathyroid Hormone/blood
• Parathyroid Hormone/urine
• Phosphates/blood
• Phosphates/metabolism
• Phosphates/urine
• Renal Insufficiency, Chronic/therapy
• Retrospective Studies
• Vitamin D/metabolism

• NOD mice
• T1D
• allograft rejection
• autoimmunity recurrence
• graft survival
• immune tolerance
• islet transplantation
• omega-3 PUFAs
• type 1 diabetes
• vitamin D

• Animals
• Diabetes Mellitus, Experimental
• Drug Evaluation, Preclinical
• Fatty Acids, Omega-3/pharmacology
• Islets of Langerhans/drug effects
• Islets of Langerhans Transplantation
• Mice
• Mice, Inbred NOD
• Transplantation, Homologous
• Vitamin D/pharmacology

Global concern about vitamin D deficiency has fuelled debates on photoprotection and the importance of solar exposure to meet vitamin D requirements.

To review the published evidence to reach a consensus on the influence of photoprotection by sunscreens on vitamin D status, considering other relevant factors.

An international panel of 13 experts in endocrinology, dermatology, photobiology, epidemiology and biological anthropology reviewed the literature prior to a 1‐day meeting in June 2017, during which the evidence was discussed. Methods of assessment and determining factors of vitamin D status, and public health perspectives were examined and consequences of sun exposure and the effects of photoprotection were assessed.

A serum level of ≥ 50 nmol L⁻¹ 25(OH)D is a target for all individuals. Broad‐spectrum sunscreens that prevent erythema are unlikely to compromise vitamin D status in healthy populations. Vitamin D screening should be restricted to those at risk of hypovitaminosis, such as patients with photosensitivity disorders, who require rigorous photoprotection. Screening and supplementation are advised for this group.

Sunscreen use for daily and recreational photoprotection does not compromise vitamin D synthesis, even when applied under optimal conditions.

What's already known about this topic?

Knowledge of the relationship between solar exposure behaviour, sunscreen use and vitamin D is important for public health but there is confusion about optimal vitamin D status and the safest way to achieve this.

What does this study add?

Judicious use of daily broad‐spectrum sunscreens with high ultraviolet (UV) A protection will not compromise vitamin D status in healthy people.

Linked Comment: https://doi.org/10.1111/bjd.18126.

https://doi.org/10.1111/bjd.18494 available online

Many physiological properties of the renal system influence nutrient metabolism, elimination, and homeostasis. Kidney failure poses significant challenges to maintaining adequate nutrition, most of which transplantation ameliorates. Comprehensive recommendations for managing nutritional derangements for patients with chronic kidney disease and end stage renal disease exist; however, there are only sparse guidelines for post-transplant malnutrition and adverse outcomes. Not only are guidelines limited, but little is known about dietary trends of post-kidney transplant recipients. This review describes guidelines for prevalent metabolic and nutritional complications post-kidney transplantation and also evaluates changes in caloric intake and diet composition after transplantation. This topic is important because nutrition influences allograft function and a number of cardiovascular risk factors including blood pressure, dyslipidemia, weight, and diabetes. In addition, many dietary recommendations and modifiable lifestyle changes should be tailored for specific complications of transplant patients, namely immunosuppression side effects, dietary restrictions, and electrolyte imbalances.

• dietary patterns
• nutrition interventions
• renal diet
• renal transplantation
• transplant comorbidities

• Hypovitaminosis D
• Renal transplant recipients
• Sensible sun exposure

• Adult
• Calcium/blood
• Cross-Sectional Studies
• Female
• Homeostasis/physiology
• Humans
• Kidney Transplantation/adverse effects
• Kidney Transplantation/trends
• Male
• Middle Aged
• Nepal/epidemiology
• Transplant Recipients
• Vitamin D/analogs & derivatives
• Vitamin D/blood
• Vitamin D Deficiency/blood
• Vitamin D Deficiency/diagnosis
• Vitamin D Deficiency/epidemiology

The risk of mineral and bone disorders among patients with chronic kidney disease is substantially elevated, owing largely to alterations in calcium, phosphorus, vitamin D, parathyroid hormone, and fibroblast growth factor 23. The interwoven relationship among these minerals and hormones results in maladaptive responses that are differentially affected by the process of kidney transplantation. Interpretation of conventional labs, imaging, and other fracture risk assessment tools are not standardized in the post-transplant setting. Post-transplant bone disease is not uniformly improved and considerable variation exists in monitoring and treatment practices. A spectrum of abnormalities such as hypophosphatemia, hypercalcemia, hyperparathyroidism, osteomalacia, osteopenia, and osteoporosis are commonly encountered in the post-transplant period. Thus, reducing fracture risk and other bone-related complications requires recognition of these abnormalities along with the risk incurred by concomitant immunosuppression use. As kidney transplant recipients continue to age, the drivers of bone disease vary throughout the post-transplant period among persistent hyperparathyroidism, de novo hyperparathyroidism, and osteoporosis. The use of anti-resorptive therapies require understanding of different options and the clinical scenarios that warrant their use. With limited studies underscoring clinical events such as fractures, expert understanding of MBD physiology, and surrogate marker interpretation is needed to determine ideal and individualized therapy.

• fracture
• kidney transplant
• mineral and bone disorder
• mineral and bone metabolism
• osteodystrophy
• osteoporosis
• post-transplant

• Bone disease
• Cardiovascular disease
• Cholecalciferol
• Chronic kidney disease
• Consensus statement
• Proteinuria
• Vitamin D

• Cholecalciferol/therapeutic use
• Humans
• Renal Insufficiency, Chronic/drug therapy
• Vitamin D Deficiency/drug therapy

• no number Abiogen Pharma SpA

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

• Calcitriol/metabolism
• Dietary Supplements
• Humans
• Kidney/metabolism
• Kidney Failure, Chronic/blood
• Kidney Failure, Chronic/metabolism
• Kidney Failure, Chronic/therapy
• Kidney Transplantation/adverse effects
• Vitamin D/administration & dosage
• Vitamin D/analogs & derivatives
• Vitamin D/metabolism
• Vitamin D Deficiency/etiology
• Vitamin D Deficiency/metabolism
• Vitamin D Deficiency/prevention & control

Reduced levels of nutritional vitamin D are commonly observed in most chronic kidney disease (CKD) patients and particularly in patients who have received a kidney transplant (KTx). In the complex clinical scenario characterizing the recipients of a renal graft, nutritional vitamin D deficiency has been put in relation not only to the changes of mineral and bone metabolism (MBM) after KTx, but also to most of the medical complications which burden KTx patients. In fact, referring to its alleged pleiotropic (non-MBM related) activities, vitamin D has been claimed to play some role in the occurrence of cardiovascular, metabolic, immunologic, neoplastic and infectious complications commonly observed in KTx recipients. Furthermore, low nutritional vitamin D levels have also been connected with graft dysfunction occurrence and progression. In this review, we will discuss the purported and the demonstrated effects of native vitamin D deficiency/insufficiency in most of the above mentioned fields, dealing separately with the MBM-related and the pleiotropic effects.

• CKD
• VDR
• calcifediol
• renal transplantation
• vitamin D

• Bone Diseases/blood
• Bone Diseases/etiology
• Humans
• Kidney Transplantation
• Observational Studies as Topic
• Randomized Controlled Trials as Topic
• Renal Insufficiency, Chronic/blood
• Renal Insufficiency, Chronic/complications
• Trace Elements/administration & dosage
• Trace Elements/blood
• Vitamin D/administration & dosage
• Vitamin D/blood
• Vitamin D Deficiency/blood
• Vitamin D Deficiency/etiology

Prediction of acute kidney transplant rejection remains imperfect despite several known risk factors. There is an increasing appreciation of the potential importance of the vitamin D pathway in immunological disease and transplantation.

The purpose of this study was to determine the association of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D with acute rejection.

This was a prospective cohort study.

Three academic adult kidney transplant programs in Ontario, Canada, were chosen.

All consecutive adult patients at the 3 institutions who received a solitary kidney transplant, were able to provide written informed consent, and planned to be followed at the same center post-operatively were included.

Serum concentration of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured at baseline, 3, and 6 months post-transplantation. Acute rejection was classified using Banff criteria.

The co-primary outcome was the association between 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D and time to first occurrence of biopsy-proven acute rejection (BPAR) within the first year after kidney transplantation. Cox proportional hazards models were fitted taking into account the time-varying nature of serum concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D.

From 556 screened patients, data on 327 kidney transplant recipients are included. First BPAR occurred in 54 (16.5%) patients. In adjusted Cox proportional hazards models, the serum concentration of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D was not associated with acute renal transplant rejection (hazard ratio 1.00; 95% [confidence interval] CI, 0.87-1.14, per 10 nmol/L increase, and hazard ratio 0.97; 95% CI, 0.84-1.12, per 10 pmol/L increase, respectively).

Given the observational design, we cannot rule out the possibility of residual confounding that limited our ability to detect a clinically significant effect of vitamin D metabolites on acute rejection.

A low serum concentration of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D is not associated with an increased risk of acute kidney transplant rejection following kidney transplantation.

• 1,25-dihydroxyvitamin D
• 25-hydroxyvitamin D
• acute rejection
• renal transplant

The aim of this study was to investigate the protective effect of 1α,25-dihydroxyvitamin D3 [1,25(OH)₂D3] on effector CD4⁺ T cells or on inflammatory cytokine-induced injury in human renal proximal tubular epithelial cells (HRPTEpiC).

First, we investigated the effect of 1,25(OH)₂D3 on CD4⁺ T cell proliferation. Second, we examined the effect of 1,25(OH)₂D3 on inflammatory cytokine secretion or fibrosis in HRPTEpiC induced by inflammatory cytokines or activated CD4⁺ T cells using ELISA and real-time PCR. Lastly, we compared urine inflammatory-cytokine (IL-6, IL-8) or KIM-1 levels in kidney transplant recipients low serum 25-hydroxyvitamin D (25(OH)D) group (< 20 ng/mL) (n = 40) and normal 25(OH)D group (n = 50).

Pre-incubation with 1,25(OH)₂D3 significantly reduced the percentages of Th1 and Th17 cells compared to that of Th0 condition (P < 0.05 for each). In contrast, 1,25(OH)₂D3 increased the proportion of Th2 and Treg cells in a dose-dependent manner (P < 0.05 for each). Treatment of HRPTEpiC with inflammatory cytokines (TNF-α, IL-17, and TGF-β) or effector CD4⁺ T cells resulted in increased production of IL-6, IL-8, or KIM-1 from HRPTEpiC in a dose-dependent manner. However, treatment with 1,25(OH)₂D3 significantly reduced the level of these cytokines (P < 0.05 for all). Western blot analysis demonstrated that the mTOR/STAT3/ERK pathway was downregulated by 1,25(OH)₂D3 in HRPTEpiC. Furthermore, the concentrations of urine IL-6/creatinine (P < 0.05) and Kim-1/creatinine (P < 0.05) were higher in the low 25(OH)D group than in the normal 25(OH)D group in kidney transplant recipients.

The results of this study suggests that vitamin D may have a significant role in the regulation of inflammation in allograft tissue in kidney transplant recipients.

All participants provided written informed consent in accordance with the Declaration of Helsinki. This study was approved by the Institutional Review Board of Seoul St. Mary’s Hospital (KC13TNMI0701).

Background: Renal transplant recipients (RTRs) are often Vitamin D (VitD) depleted as a result of both chronic kidney disease and mandated sun avoidance behaviours. Repleting VitD may be warranted, but how, and for how long, is unknown, as is the impact of seasonality on the success of repletion. We investigated the impact of seasonality on VitD status following VitD repletion in a large cohort of stable, long-term RTRs.

Methods: Serum 25-hydroxyvitamin D [25(OH)D] concentrations and bone biochemistry parameters were analysed from 102 VitD repletion courses in 98 RTRs that had undergone VitD repletion. Repletion was delivered over 6 months with either 240 000 IU colecalciferol if pre-repletion serum VitD was between 20 and 50 nmol/L, or with 360 000 IU if VitD was <20 nmol/L. Twelve months post-repletion 25(OH)D and parathyroid hormone (PTH) were available for 75 patients.

Results: At baseline, 25(OH)D was 20.1 ± 1.0 nmol/L, increasing to 65.4 ± 1.8 nmol/L following repletion (+7.55 nmol/L/month, P < 0.0001). Twelve months post-repletion and after no further VitD administration, 25(OH)D fell to 35.4 ± 1.8 nmol/L (14.2 ± 0.7 ng/mL; −2.50 nmol/L/month, P < 0.0001). PTH followed the opposite trend with baseline, repletion-end and post-repletion values being 144.2 ± 12.0, 109.6 ± 7.5 and 129.2 ± 11.4 ng/L, respectively. VitD repletion during the summer was associated with significantly higher at repletion-end 25(OH)D compared with any other time of year [summer 80.9 ± 4.0, autumn 64.1 ± 3.0 (P = 0.002), winter 48.9 ± 3.0 (P <0.001), spring 63.8 ± 2.5 nmol/L (P <0.001)]. There was no hypercalcaemia during repletion and renal transplant function remained stable without any evidence of allograft rejection.

Conclusions: VitD repletion can safely and effectively be achieved in the majority of chronic stable RTRs using a 6-month bolus intermediate-dose schedule. Winter repletion is associated with an inadequate response in 25(OH)D; however, all patients experience a post-repletion fall towards deficiency in the absence of maintenance supplementation, irrespective of the season of repletion.

• bone mineral disease
• chronic kidney disease
• renal transplantation
• vitamin D

• Chronic kidney disease
• Dialysis
• Kidney transplantation
• Vitamin D

• Bone Diseases/drug therapy
• Dietary Supplements
• Humans
• Kidney Transplantation
• Minerals/metabolism
• Parathyroid Hormone/blood
• Practice Guidelines as Topic
• Renal Dialysis
• Renal Insufficiency, Chronic/drug therapy
• Trace Elements/metabolism
• Vascular Calcification/etiology
• Vitamin D/adverse effects
• Vitamin D/therapeutic use

After successful kidney transplantation, accumulated waste products and electrolytes are excreted and regulatory hormones return to normal levels. Despite the improvement in mineral metabolites and mineral regulating hormones after kidney transplantation, abnormal bone and mineral metabolism continues to present in most patients. During the first 3 mo, fibroblast growth factor-23 (FGF-23) and parathyroid hormone levels decrease rapidly in association with an increase in 1,25-dihydroxyvitamin D production. Renal phosphate excretion resumes and serum calcium, if elevated before, returns toward normal levels. FGF-23 excess during the first 3-12 mo results in exaggerated renal phosphate loss and hypophosphatemia occurs in some patients. After 1 year, FGF-23 and serum phosphate return to normal levels but persistent hyperparathyroidism remains in some patients. The progression of vascular calcification also attenuates. High dose corticosteroid and persistent hyperparathyroidism are the most important factors influencing abnormal bone and mineral metabolism in long-term kidney transplant (KT) recipients. Bone loss occurs at a highest rate during the first 6-12 mo after transplantation. Measurement of bone mineral density is recommended in patients with estimated glomerular filtration rate > 30 mL/min. The use of active vitamin D with or without bisphosphonate is effective in preventing early post-transplant bone loss. Steroid withdrawal regimen is also beneficial in preservation of bone mass in long-term. Calcimimetic is an alternative therapy to parathyroidectomy in KT recipients with persistent hyperparathyroidism. If parathyroidectomy is required, subtotal to near total parathyroidectomy is recommended. Performing parathyroidectomy during the waiting period prior to transplantation is also preferred in patients with severe hyperparathyroidism associated with hypercalcemia.

• Phosphaturia
• Tertiary hyperparathyroidism
• Phosphatonin
• Renal transplantation
• Bone mineral density

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

• 25-hydroxyvitamin D
• calcineurin inhibitors
• immunosuppressive agents
• renal transplantation

Hypovitaminosis D has been frequently reported after renal transplantation, but the impact of obesity and other factors in the reduction of vitamin D levels is not well established. We aimed to evaluate risk factors contributing to hypovitaminosis D among nondiabetic renal transplant recipients (RTR) with serum creatinine <2.0 mg/dL, at least 6 months after transplantation.

One hundred RTR were subjected to anthropometric evaluation and body composition assessment through bioelectrical impedance analysis; blood samples were drawn for biochemical and hormonal determinations and clinical data were retrieved from the medical records.

Hypovitaminosis D was observed in 65% and overweight (body mass index, BMI >25 kg/m²) in 59% of cases with a significant median weight gain after transplantation of 5.1 kg. An inadequate distribution of body fat was evidenced in 50% of males and in 58% of females. Patients with either vitamin D deficiency or insufficiency presented significantly higher median values of body fat and weight gain since transplantation, as well as lower lean mass compared with patients with normal vitamin D levels (P < 0.001). Moreover, median values of waist circumference, BMI, serum leptin and parathyroid hormone levels were significantly higher in the group with vitamin D deficiency. A multivariate linear regression analysis then revealed that body fat and leptin levels, but not skin color, gender, age, glucocorticoid use, renal function, microalbuminuria and other confounding factors, were independently associated with low levels of 25 hydroxyvitamin D3 even after adjustments for seasonal variations.

In conclusion, the present study showed body fat and serum leptin levels to be the only independent risk factors for hypovitaminosis D among RTR.

• obesity
• overweight
• renal transplantation
• serum leptin
• vitamin D

• Adult
• Aged
• Cohort Studies
• Female
• Glomerular Filtration Rate/physiology
• Graft Rejection/blood
• Graft Rejection/etiology
• Graft Rejection/physiopathology
• Graft Survival/physiology
• Humans
• Kidney Transplantation
• Male
• Middle Aged
• Prospective Studies
• Vitamin D/analogs & derivatives
• Vitamin D/blood
• Vitamin D Deficiency/blood
• Vitamin D Deficiency/complications
• Vitamin D Deficiency/physiopathology

Among patients with organ failure, vitamin D deficiency is extremely common and frequently does not resolve after transplantation. This review crystallizes and summarizes existing data on the status quo of vitamin D deficiency in patients with organ failure and in solid organ transplant recipients. Interventional studies evaluating different treatment strategies, as well as current clinical practice guidelines and recommendations on the management of low vitamin D status in these patients are also discussed.

• Adult
• Cross-Sectional Studies
• Female
• Fibroblast Growth Factor-23
• Fibroblast Growth Factors/blood
• Glomerular Filtration Rate
• Humans
• Hypophosphatemia/blood
• Hypophosphatemia/physiopathology
• Kidney Failure, Chronic/blood
• Kidney Failure, Chronic/physiopathology
• Kidney Failure, Chronic/surgery
• Kidney Transplantation
• Male
• Middle Aged
• Parathyroid Hormone/blood
• Renal Dialysis