Jiménez Álvaro S, Marcén R, Villacorta J, Fernández-Rodríguez A, Galeano C, Villafruela J J, Teruel J L, Burgos F J, Quereda C
Department of Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
Transplant Proc. 2010 Oct;42(8):2921-3. doi: 10.1016/j.transproceed.2010.07.067.
Most renal transplant recipients display vitamin D deficiency or insufficiency. The KDIGO guidelines suggest that this deficit should be treated as in the general population. Since there are few studies about the effects of cholecalciferol in de novo renal transplant recipients, we sought to assess these effects in long-term kidney graft recipients. Among 37 renal transplant recipients (19 males, 18 females) at a mean of 105±82 months posttransplantation, vitamin D insufficiency or deficiency was treated with cholecalciferol (400-800 IU/d) plus calcium supplements (600-1200 mg/d of elemental calcium). These subjects were compared with 37 untreated recipients for a period between 6 and 12 months. At baseline, there were no differences between the groups in age at transplantation, sex, length of follow-up after grafting, function measured by estimated glomerular filtration rate (44.4±16.8 treated vs 42.0±15.0 mL/min/1.73 m2 untreated; P=.527); iPTH (157±103 treated vs 176±118 pg/mL untreated; P=.461); 25OHD (14.7±4.7 treated vs 15.7±9.7 ng/mL untreated; P=.584); or 1.25OHD (34.1±26.0 treated vs 34.0±13.0 pg/mL untreated; P=.950). When compared with baseline values, iPTH (157±103 vs 144±89 pg/mL; P=.11) and 1.25OHD levels at 6 months (34.1±26.0 vs 35.9±26.3 pg/mL; P=.282) showed no change but 25OHD levels (14.7±4.7 vs 22.6±7.4 ng/mL; P=.000) and phosphate tubular reabsorption (64%±17% baseline vs 69%±14% at 6 months; P=.030) were increased in the treated patients. There were no differences in the parameters studied in untreated patients. Among the 27 recipients followed at 12 months, iPTH was decreased compared with baseline values (157±103 vs 124±62 pg/mL; P=.024) and 25OHD remained stable with respect to the values at 6 months (21.1±5.3 ng/mL). No adverse effects of cholecalciferol were observed such as those to increase urinary calcium excretion. Low doses of cholecalciferol improved vitamin D status and decreased iPTH levels at 12 months. Higher doses than those used in our study are needed to increase serum 25OHD concentrations above 30 ng/mL.
大多数肾移植受者存在维生素D缺乏或不足。KDIGO指南建议，这种缺乏应与普通人群一样进行治疗。由于关于胆钙化醇对初发肾移植受者影响的研究较少，我们试图评估其对长期肾移植受者的影响。在37例肾移植受者（19例男性，18例女性）中，平均移植后105±82个月，维生素D不足或缺乏者接受胆钙化醇（400 - 800 IU/d）加钙补充剂（元素钙600 - 1200 mg/d）治疗。将这些受试者与37例未治疗的受者进行6至12个月的比较。基线时，两组在移植时的年龄、性别、移植后随访时间、通过估计肾小球滤过率测量的功能（治疗组44.4±16.8 vs未治疗组42.0±15.0 mL/min/1.73 m²；P = 0.527）；iPTH（治疗组157±103 vs未治疗组176±118 pg/mL；P = 0.461）；25OHD（治疗组14.7±4.7 vs未治疗组15.7±9.7 ng/mL；P = 0.584）；或1,25OHD（治疗组34.1±26.0 vs未治疗组34.0±13.0 pg/mL；P = 0.950）方面均无差异。与基线值相比，治疗组6个月时iPTH（157±103 vs 144±89 pg/mL；P = 0.11）和1,25OHD水平（34.1±26.0 vs 35.9±26.3 pg/mL；P = 0.282）无变化，但治疗组25OHD水平（14.7±4.7 vs 22.6±7.4 ng/mL；P = 0.000）和磷酸盐肾小管重吸收（基线64%±17% vs 6个月时69%±14%；P = 0.030）升高。未治疗患者所研究的参数无差异。在27例随访12个月的受者中，iPTH较基线值降低（157±103 vs 124±62 pg/mL；P = 0.024），25OHD相对于第6个月时的值保持稳定（21.1±5.3 ng/mL）。未观察到胆钙化醇的不良反应，如增加尿钙排泄。低剂量胆钙化醇在12个月时改善了维生素D状态并降低了iPTH水平。需要比我们研究中使用的剂量更高的剂量才能使血清25OHD浓度升高至30 ng/mL以上。
