Failure of successful renal transplant to produce appropriate levels of 1,25-dihydroxyvitamin D

Maria Fleseriu, A. A. Licata

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Introduction: Bone metabolism disturbances following renal transplantation (RT) are complex and multifactorial in origin. Abnormalities in 1,25-dihydroxyvitamin D levels in RT patients under treatment at our Bone Center prompted this retrospective study. Methods: Parameters of vitamin D metabolism were compared in RT patients and a cohort of patients with primary hyperparathyroidism (PHTP) who mimicked the hyperparathyroid state of the RT patients. Thirty-one RT recipients (from 300 reviewed) matched our inclusion criteria with a stable graft function for more than 1 year and a glomerular filtration rate (GFR) >50 mL/min per 1.73 m2 (Group A); these were compared with 42 consecutive patients with PHTP who had been referred to the same Bone Center for treatment for over 1 month (Group B). Statistical analysis included the chi-square or Fisher's exact tests for categorical data and the Wilcoxon rank sum test for quantitative measures. Results: The mean (±SD) 1,25-dihydroxyvitamin D level was significantly lower (p <0.001) in Group A patients (29.8 ± 16.2) than in Group B patients (70.2 ± 25.9) despite non-significant differences in the levels of parathyroid hormone (PTH) (mean: 184.0 vs.101.1;p <0.29), phosphorus (mean: 3.2 vs. 3.1; p <0.3) and 1,25-vitamin D (mean: 19.5 vs. 25.2; p <0.06). Group A patients had lower levels (p <0.05) of mean serum calcium and calculated GFR (9.3 mg/dL, 65.7 mL/min) than Group B patients (10.6 mg/dL, 97.6 mL/min). 1,25-Dihydroxyvitamin D significantly correlated with calcium (p <0.001), 25-vitamin D (p <0.005) and GFR (p <0.001) in both groups, but there was a notable lack of association between 1,25-dihydroxyvitamin D and PTH (p <0.64) or phosphorus (p <0.26) in Group A patients. In this group, 1,25-dihydroxyvitamin D was not influenced by the type of immunosuppresion regimen (p <0.06), use of biphosphonates (p <0.73), presence of diabetes (p <0.59), menopause in women (p <0.08), season (p <0.43) or race (p <0.31). Our data indicate that 1,25-dihydroxyvitamin D metabolism remains disturbed for a considerable time after successful RT, with the result that the level of 1,25-dihydroxyvitamin D in RT patients is lower despite physiological signals that should stimulate its production. Our analysis of many clinical variables was unable to elucidate the underlying mechanism(s) for this disturbance. Conclusion: Successful RT may not produce appropriate levels of 1,25-dihydroxyvitamin D commensurate to the elevated levels of PTH. This abnormality along with sustained hyperparathyroidism may contribute to bone loss following transplantation.

Original languageEnglish (US)
Pages (from-to)363-368
Number of pages6
JournalOsteoporosis International
Volume18
Issue number3
DOIs
StatePublished - Mar 2007
Externally publishedYes

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Renal Insufficiency
Kidney Transplantation
Transplants
Parathyroid Hormone
Glomerular Filtration Rate
Vitamin D
Bone and Bones
Nonparametric Statistics
Phosphorus
1,25-dihydroxyvitamin D
Calcium
Primary Hyperparathyroidism
Hyperparathyroidism
Menopause
Retrospective Studies
Transplantation
Therapeutics
Serum

Keywords

  • 1,25 dihydroxyvitamin D
  • Hyperparathyroidism
  • Physiology
  • Renal osteodystrophy
  • Renal transplant

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Failure of successful renal transplant to produce appropriate levels of 1,25-dihydroxyvitamin D. / Fleseriu, Maria; Licata, A. A.

In: Osteoporosis International, Vol. 18, No. 3, 03.2007, p. 363-368.

Research output: Contribution to journalArticle

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abstract = "Introduction: Bone metabolism disturbances following renal transplantation (RT) are complex and multifactorial in origin. Abnormalities in 1,25-dihydroxyvitamin D levels in RT patients under treatment at our Bone Center prompted this retrospective study. Methods: Parameters of vitamin D metabolism were compared in RT patients and a cohort of patients with primary hyperparathyroidism (PHTP) who mimicked the hyperparathyroid state of the RT patients. Thirty-one RT recipients (from 300 reviewed) matched our inclusion criteria with a stable graft function for more than 1 year and a glomerular filtration rate (GFR) >50 mL/min per 1.73 m2 (Group A); these were compared with 42 consecutive patients with PHTP who had been referred to the same Bone Center for treatment for over 1 month (Group B). Statistical analysis included the chi-square or Fisher's exact tests for categorical data and the Wilcoxon rank sum test for quantitative measures. Results: The mean (±SD) 1,25-dihydroxyvitamin D level was significantly lower (p <0.001) in Group A patients (29.8 ± 16.2) than in Group B patients (70.2 ± 25.9) despite non-significant differences in the levels of parathyroid hormone (PTH) (mean: 184.0 vs.101.1;p <0.29), phosphorus (mean: 3.2 vs. 3.1; p <0.3) and 1,25-vitamin D (mean: 19.5 vs. 25.2; p <0.06). Group A patients had lower levels (p <0.05) of mean serum calcium and calculated GFR (9.3 mg/dL, 65.7 mL/min) than Group B patients (10.6 mg/dL, 97.6 mL/min). 1,25-Dihydroxyvitamin D significantly correlated with calcium (p <0.001), 25-vitamin D (p <0.005) and GFR (p <0.001) in both groups, but there was a notable lack of association between 1,25-dihydroxyvitamin D and PTH (p <0.64) or phosphorus (p <0.26) in Group A patients. In this group, 1,25-dihydroxyvitamin D was not influenced by the type of immunosuppresion regimen (p <0.06), use of biphosphonates (p <0.73), presence of diabetes (p <0.59), menopause in women (p <0.08), season (p <0.43) or race (p <0.31). Our data indicate that 1,25-dihydroxyvitamin D metabolism remains disturbed for a considerable time after successful RT, with the result that the level of 1,25-dihydroxyvitamin D in RT patients is lower despite physiological signals that should stimulate its production. Our analysis of many clinical variables was unable to elucidate the underlying mechanism(s) for this disturbance. Conclusion: Successful RT may not produce appropriate levels of 1,25-dihydroxyvitamin D commensurate to the elevated levels of PTH. This abnormality along with sustained hyperparathyroidism may contribute to bone loss following transplantation.",
keywords = "1,25 dihydroxyvitamin D, Hyperparathyroidism, Physiology, Renal osteodystrophy, Renal transplant",
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T1 - Failure of successful renal transplant to produce appropriate levels of 1,25-dihydroxyvitamin D

AU - Fleseriu, Maria

AU - Licata, A. A.

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N2 - Introduction: Bone metabolism disturbances following renal transplantation (RT) are complex and multifactorial in origin. Abnormalities in 1,25-dihydroxyvitamin D levels in RT patients under treatment at our Bone Center prompted this retrospective study. Methods: Parameters of vitamin D metabolism were compared in RT patients and a cohort of patients with primary hyperparathyroidism (PHTP) who mimicked the hyperparathyroid state of the RT patients. Thirty-one RT recipients (from 300 reviewed) matched our inclusion criteria with a stable graft function for more than 1 year and a glomerular filtration rate (GFR) >50 mL/min per 1.73 m2 (Group A); these were compared with 42 consecutive patients with PHTP who had been referred to the same Bone Center for treatment for over 1 month (Group B). Statistical analysis included the chi-square or Fisher's exact tests for categorical data and the Wilcoxon rank sum test for quantitative measures. Results: The mean (±SD) 1,25-dihydroxyvitamin D level was significantly lower (p <0.001) in Group A patients (29.8 ± 16.2) than in Group B patients (70.2 ± 25.9) despite non-significant differences in the levels of parathyroid hormone (PTH) (mean: 184.0 vs.101.1;p <0.29), phosphorus (mean: 3.2 vs. 3.1; p <0.3) and 1,25-vitamin D (mean: 19.5 vs. 25.2; p <0.06). Group A patients had lower levels (p <0.05) of mean serum calcium and calculated GFR (9.3 mg/dL, 65.7 mL/min) than Group B patients (10.6 mg/dL, 97.6 mL/min). 1,25-Dihydroxyvitamin D significantly correlated with calcium (p <0.001), 25-vitamin D (p <0.005) and GFR (p <0.001) in both groups, but there was a notable lack of association between 1,25-dihydroxyvitamin D and PTH (p <0.64) or phosphorus (p <0.26) in Group A patients. In this group, 1,25-dihydroxyvitamin D was not influenced by the type of immunosuppresion regimen (p <0.06), use of biphosphonates (p <0.73), presence of diabetes (p <0.59), menopause in women (p <0.08), season (p <0.43) or race (p <0.31). Our data indicate that 1,25-dihydroxyvitamin D metabolism remains disturbed for a considerable time after successful RT, with the result that the level of 1,25-dihydroxyvitamin D in RT patients is lower despite physiological signals that should stimulate its production. Our analysis of many clinical variables was unable to elucidate the underlying mechanism(s) for this disturbance. Conclusion: Successful RT may not produce appropriate levels of 1,25-dihydroxyvitamin D commensurate to the elevated levels of PTH. This abnormality along with sustained hyperparathyroidism may contribute to bone loss following transplantation.

AB - Introduction: Bone metabolism disturbances following renal transplantation (RT) are complex and multifactorial in origin. Abnormalities in 1,25-dihydroxyvitamin D levels in RT patients under treatment at our Bone Center prompted this retrospective study. Methods: Parameters of vitamin D metabolism were compared in RT patients and a cohort of patients with primary hyperparathyroidism (PHTP) who mimicked the hyperparathyroid state of the RT patients. Thirty-one RT recipients (from 300 reviewed) matched our inclusion criteria with a stable graft function for more than 1 year and a glomerular filtration rate (GFR) >50 mL/min per 1.73 m2 (Group A); these were compared with 42 consecutive patients with PHTP who had been referred to the same Bone Center for treatment for over 1 month (Group B). Statistical analysis included the chi-square or Fisher's exact tests for categorical data and the Wilcoxon rank sum test for quantitative measures. Results: The mean (±SD) 1,25-dihydroxyvitamin D level was significantly lower (p <0.001) in Group A patients (29.8 ± 16.2) than in Group B patients (70.2 ± 25.9) despite non-significant differences in the levels of parathyroid hormone (PTH) (mean: 184.0 vs.101.1;p <0.29), phosphorus (mean: 3.2 vs. 3.1; p <0.3) and 1,25-vitamin D (mean: 19.5 vs. 25.2; p <0.06). Group A patients had lower levels (p <0.05) of mean serum calcium and calculated GFR (9.3 mg/dL, 65.7 mL/min) than Group B patients (10.6 mg/dL, 97.6 mL/min). 1,25-Dihydroxyvitamin D significantly correlated with calcium (p <0.001), 25-vitamin D (p <0.005) and GFR (p <0.001) in both groups, but there was a notable lack of association between 1,25-dihydroxyvitamin D and PTH (p <0.64) or phosphorus (p <0.26) in Group A patients. In this group, 1,25-dihydroxyvitamin D was not influenced by the type of immunosuppresion regimen (p <0.06), use of biphosphonates (p <0.73), presence of diabetes (p <0.59), menopause in women (p <0.08), season (p <0.43) or race (p <0.31). Our data indicate that 1,25-dihydroxyvitamin D metabolism remains disturbed for a considerable time after successful RT, with the result that the level of 1,25-dihydroxyvitamin D in RT patients is lower despite physiological signals that should stimulate its production. Our analysis of many clinical variables was unable to elucidate the underlying mechanism(s) for this disturbance. Conclusion: Successful RT may not produce appropriate levels of 1,25-dihydroxyvitamin D commensurate to the elevated levels of PTH. This abnormality along with sustained hyperparathyroidism may contribute to bone loss following transplantation.

KW - 1,25 dihydroxyvitamin D

KW - Hyperparathyroidism

KW - Physiology

KW - Renal osteodystrophy

KW - Renal transplant

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