Yadav Ashok Kumar, Tiwana Sanveer, Steel Matthew, Ramachandran Raja, Kaski Juan C, Jha Vivekanand, Banerjee Debasish
Department of Nephrology, Post Graduate Medical Education and Research, Chandigarh, India.
Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St Georges University of London, London, UK.
Int Urol Nephrol. 2019 Jan;51(1):181-186. doi: 10.1007/s11255-018-2014-7. Epub 2018 Nov 19.
CKD patients after kidney transplantation continue to suffer from elevated CV events which may be related to low vitamin D and its adverse impact on vascular function. The prevalence of vitamin D deficiency in North Indian kidney transplantation patients and its impact on vascular and bone biomarkers is unknown which this study investigated.
Non-diabetic, stable, > 6 months post-kidney transplantation patients, not on vitamin D supplementation, were recruited after informed consent. Data on demographics, anthropometrics and treatment were collected. Blood samples were stored at - 80 °C until analysis for bone and endothelial cell biomarkers using standard ELISA techniques.
The clinical characteristics were: age 37.4 ± 9.9 years, 80% men, 27% ex-smokers, BP 125.5 ± 15.7/78.6 ± 9.7 mmHg, cholesterol 172.0 ± 47.8 mg/dL, hemoglobin 12.6 ± 2.3 g/dL, calcium 9.5 ± 0.6 mg/d and iPTH 58.4 ± 32.9 ng/mL and vitamin D 36.5 ± 39.8 nmol/L. Patients with vitamin D < 37.5 nmol/L (66%) had similar age, serum creatinine, serum phosphate, iPTH, blood pressure but lower calcium (9.3 ± 0.7 vs. 9.6 ± 0.5 mg/dL; p = 0.024), lower FGF23 (median 18.8 vs. 80.0 pg/mL; p = 0.013) and higher E-selectin (15.8 ± 7.9 vs. 13.0 ± 5.5 ng/mL; p = 0.047). On Univariate analysis, E-selectin (r = - 0.292; p = 0.005), FGF23 (r = 0.217; p = 0.036) and calcium (r = 0.238; p = 0.022) were significantly correlated with vitamin D levels. On stepwise multiple regression analysis, only E-selectin was associated with vitamin D levels (β = - 0.324; p = 0.002).
Vitamin D deficiency was common in kidney transplant recipients in North India, associated with low FGF23 and high E-selectin. These findings suggest further investigations to assess the role of vitamin D deficiency-associated endothelial dysfunction, its implications and reversibility in kidney transplantation recipients.
肾移植后的慢性肾脏病（CKD）患者仍面临心血管事件风险升高的问题，这可能与维生素D水平低及其对血管功能的不利影响有关。北印度肾移植患者维生素D缺乏的患病率及其对血管和骨生物标志物的影响尚不清楚，本研究对此进行了调查。
招募非糖尿病、病情稳定、肾移植术后超过6个月且未补充维生素D的患者，并获得其知情同意。收集人口统计学、人体测量学和治疗方面的数据。血样保存在-80°C，直至使用标准酶联免疫吸附测定（ELISA）技术分析骨和内皮细胞生物标志物。
临床特征如下：年龄37.4±9.9岁，男性占80%，既往吸烟者占27%，血压125.5±15.7/78.6±9.7mmHg，胆固醇172.0±47.8mg/dL，血红蛋白12.6±2.3g/dL，钙9.5±0.6mg/d，全段甲状旁腺激素（iPTH）58.4±32.9ng/mL，维生素D 36.5±39.8nmol/L。维生素D<37.5nmol/L的患者（66%）年龄、血清肌酐、血清磷酸盐、iPTH、血压相似，但钙水平较低（9.3±0.7 vs. 9.6±0.5mg/dL；p=0.024），成纤维细胞生长因子23（FGF23）较低（中位数18.8 vs. 80.0pg/mL；p=0.013），E选择素较高（15.8±7.9 vs. 13.0±5.5ng/mL；p=0.047）。单因素分析显示，E选择素（r=-0.292；p=0.005）、FGF23（r=0.217；p=0.036）和钙（r=0.238；p=0.022）与维生素D水平显著相关。逐步多元回归分析显示，只有E选择素与维生素D水平相关（β=-0.324；p=0.002）。
维生素D缺乏在北印度肾移植受者中很常见，与低FGF23和高E选择素有关。这些发现提示需要进一步研究，以评估维生素D缺乏相关的内皮功能障碍在肾移植受者中的作用、影响及其可逆性。
