A Controlled Study of Vitamin D3 to Prevent Bone Loss in Renal-Transplant Patients Receiving Low Doses of Steroids

Wissing, Karl Martin; Broeders, Nilüfer; Moreno‐Reyes, Rodrigo; Gervy, Christine; Stallenberg, Bernard; Abramowicz, Daniel

doi:10.1097/01.tp.0000149322.70295.a5

Cited by 102 publications

(62 citation statements)

References 32 publications

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“…Despite hypophosphatemia and hyperparathyroidism, conditions that are known to stimulate increased calcitriol synthesis (21), serum calcitriol levels remain often at the lower range in the early posttransplantation period (38,39). In this study, high calcitriol levels were observed to be independently associated with female gender, good renal function, and high calcidiol and PTH levels.…”

Section: Discussionmentioning

confidence: 50%

Calcium Metabolism in the Early Posttransplantation Period

Evenepoel

Bergh²,

Naesens³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Information on the time course of serum calcium levels after renal transplantation is scanty, especially in the early posttransplantation period. Both the abrupt cessation of calcium-containing phosphorus binders and vitamin D (analogs) at the time of surgery and the recovery of renal function may be hypothesized to affect serum calcium levels in this period.Design, setting, participants, & measurements: In this prospective observational study, biointact parathyroid hormone, calcidiol, calcitriol, calcium, and phosphorus levels were monitored in 201 renal transplant recipients at the time of transplantation and 3 mo thereafter. In addition, the serum calcium nadir and peak in each individual patient within this time frame were identified and the urinary fractional calcium excretion was determined at month 3.Results: Serum calcium levels followed a biphasic pattern with a significant decline during the first postoperative week, followed by a significant increase. High pretransplantation parathyroid hormone levels protect against hypocalcemia within the first postoperative week but put patients at risk for hypercalcemia later. These complications, occurring in 41 and 14% of the patients, respectively, most probably reflect inappropriate calcium release from the skeleton, rather than inappropriate renal calcium handling.Conclusions: Our data indicate that both hypo-and hypercalcemia are prevalent in the early posttransplantation period. Pretransplantation parathyroid function is an important predictor of posttransplantation calcium levels.

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Section: Discussionmentioning

confidence: 50%

Calcium Metabolism in the Early Posttransplantation Period

Evenepoel

Bergh²,

Naesens³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Another important result of this study is to show that lowdose steroid therapy induces minimal bone loss. In our study, different from Wissing et al, [27] low-dose vitamin D3 and calcium supplementation has reduced bone loss and normalized PTH levels.…”

Section: Discussioncontrasting

confidence: 39%

“…[25] On the contrary, Mikuls et al reported only a minor loss of lumbar spine and no loss of femoral neck BMD during the first six posttransplant months in spite of a higher cumulative prednisolone dose of 4.2 g in the same period. [26] In another study by Wissing et al, [27] a single dose of 25,000 IU vitamin D3 monthly implementation had no effect on bone loss but normalized PTH levels on transplantation patients compared with control group. Another important result of this study is to show that lowdose steroid therapy induces minimal bone loss.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Low-Dose Cholecalciferol and Calcium Treatment on Posttransplant Bone Loss in Renal Transplant Patients: A Prospective Study

et al. 2008

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Background/Aim. Posttransplant steroid doses have been reduced with the use of new and potent immunosuppressive agents. However, posttransplant osteoporosis is still a serious problem. Our aim in this study was to investigate the effect of low-dose cholecalciferol and calcium supplementation on bone loss after transplantation in renal transplant patients. Methods. Fifty-eight renal transplantation patients were included in the study. Fourteen newly transplanted patients (group 1) and 44 renal transplantation patients with a graft age of at least six months (group 2) were involved. All patients received 400 IU/ day orally cholecalciferol (vitamin D3) and 600 mg/day orally calcium replacement starting from the second day posttransplantion. All patients baseline serum and urine biochemistry, serum 25-hydroxy vitamin D3 (25 (OH)D3), and bone mineral density (BMD) tests were performed. Also, the same measurements were performed at the 12th month in group 1. Results. After one year of treatment, BMDs were improved in group 1. Patients in group 1 had a nonsignificant increase of lumbar spine (8.12 ± 18.64% of baseline BMD) and femoral total (7.10 ± 13.48% of baseline BMD) BMD at the end of the first year. On the other hand, there was a significant increase in femoral neck (10.06 ± 15.70% of baseline BMD, p < 0.05) measurements. The baseline results of group 2 were similar to group 1. In group 1, 25 (OH)D3 levels were increased while PTH levels were decreased at the end of the year. Conclusion. In renal transplant patients who use low-dose metilprednisolon and new immunosuppressive agents together, low doses of vitamin D3 and calcium replacement for one year provides a reduction in lumbar spine, femoral neck, and femoral total bone loss and prevents bone loss in group 2. In addition, it contributed to the normalization of PTH levels.

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“…60 Studies from our group and other have already shown that cholecalciferol supplementation is a safe way to increase 25 (OH)D concentrations in kidney transplant recipients, but the small number of treated patients included in these studies and their short follow-up do not allow any conclusion on the effect of these treatments on kidney function. [61][62][63] Our results should encourage randomized controlled trials evaluating the effect of early cholecalciferol supplementation on renal allograft function and provide valuable information on the magnitude of the expected effects of such treatments on renal function and histologic features.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Status and Outcomes After Renal Transplantation

Bienaimé

Girard

Anglicheau

et al. 2013

Journal of the American Society of Nephrology

100

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Kidney transplant recipients usually have low vitamin D levels, especially in the early posttransplantation period, but the association between vitamin D status with renal outcomes is not well described in this population. Here, we studied a prospective cohort of 634 kidney recipients who underwent transplantation at a single institution between January 2005 and June 2010. In this cohort, low 25-hydroxyvitamin D concentrations 3 months after transplantation did not predict early death or graft loss but were independently associated with lower measured GFR at 12 months (P=0.001) and higher risk for interstitial fibrosis and tubular atrophy (P=0.01). In contrast, levels of calcium, phosphorus, calcitriol, parathyroid hormone, or fibroblast growth factor-23 were not consistently associated with any of the studied outcomes. In conclusion, low 25-hydroxyvitamin D concentration measured 3 months after transplantation is an independent risk factor for interstitial fibrosis progression and is associated with a lower GFR 1 year after transplantation. 24: 831-841, 201324: 831-841, . doi: 10.1681 Kidney transplantation is the preferred treatment for the increasing number of patients with ESRD. Transplantation allows patients to avoid the heavy constraints associated with dialysis therapy and is associated with a lower mortality and morbidity than is hemodialysis. 1 Evolution of GFR in transplant recipients appears to be imprinted at an early stage after the surgery. Indeed, the estimated GFR (eGFR) reached 1 year after transplantation is critically associated with allograft outcome. 2,3 This observation prompts research on modifiable factors affecting GFR in the first year after transplantation. J Am Soc NephrolVitamin D is a critical hormone controlling mineral homeostasis. It promotes phosphate and calcium absorption by the gut and increases calcium reabsorption by the renal distal tubule, thereby providing the positive calcium and phosphorus flux required for bone mineralization.

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A Controlled Study of Vitamin D3 to Prevent Bone Loss in Renal-Transplant Patients Receiving Low Doses of Steroids

Cited by 102 publications

References 32 publications

Calcium Metabolism in the Early Posttransplantation Period

Calcium Metabolism in the Early Posttransplantation Period

The Effect of Low-Dose Cholecalciferol and Calcium Treatment on Posttransplant Bone Loss in Renal Transplant Patients: A Prospective Study

Vitamin D Status and Outcomes After Renal Transplantation

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