Image_2_25(OH)D-but not 1,25(OH)2D–Is an independent risk factor predicting graft loss in stable kidney transplant recipients.pdf

BackgroundVitamin 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.MethodsWe 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.ResultsCompared 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).ConclusionBaseline 25(OH)D concentrations but not 1,25(OH)2D concentrations were independently and inversely associated with graft loss in adult KTRs.</p

Image_1_25(OH)D-but not 1,25(OH)2D–Is an independent risk factor predicting graft loss in stable kidney transplant recipients.pdf

BackgroundVitamin 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.MethodsWe 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.ResultsCompared 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).ConclusionBaseline 25(OH)D concentrations but not 1,25(OH)2D concentrations were independently and inversely associated with graft loss in adult KTRs.</p

Course of the study.

<p>Course of the study.</p

Model of megalin function in renal uptake and activation of 25-(OH) Vitamin D3. [11]

<p>Model of megalin function in renal uptake and activation of 25-(OH) Vitamin D3. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145723#pone.0145723.ref011" target="_blank">11</a>]</p

Urinary cGMP predicts major adverse renal events in patients with mild renal impairment and/or diabetes mellitus before exposure to contrast medium - Fig 3

<p><b>Distribution of urinary cGMP/creatinine ratios (μM/mM) before 24 hours after and 48h after contrast media application detected in patients without (No) or with (Yes) following adverse events: death(a), dialysis (b) or MARE (c).</b><i>cGMP</i>: <i>urinary cyclic guanosine monophosphate</i>, <i>MARE</i>: <i>major adverse renal event</i>, <i>*** p<0</i>.<i>001</i>, <i>** p<0</i>.<i>01</i>, <i>* p<0</i>.<i>05</i>.</p

Urinary cGMP predicts major adverse renal events in patients with mild renal impairment and/or diabetes mellitus before exposure to contrast medium - Fig 4

<p>ROC-curves of the cGMP/Creatinine ratio before CM application for (a) death, (b) dialysis and (c) MARE.</p

Multivariate logistic regression analysis for predictors of MARE.

<p>Multivariate logistic regression analysis for predictors of MARE.</p

Flow chart for sample collection.

<p>Flow chart for sample collection.</p

Urinary cGMP predicts major adverse renal events in patients with mild renal impairment and/or diabetes mellitus before exposure to contrast medium - Fig 2

<p><b>Histogram of cGMP/Creatinine ratio (μM/mM) (a) before, (b) 24h after and (c) 48h after CM application.</b><i>cGMP</i>: <i>urinary cyclic guanosine monophosphate</i>.</p

Overview of study endpoints.

<p>Overview of study endpoints.</p