The impact of vitamin D deficiency on patients undergoing kidney transplantation: focus on cardiovascular, metabolic, an
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MINI REVIEW
The impact of vitamin D deficiency on patients undergoing kidney transplantation: focus on cardiovascular, metabolic, and endocrine outcomes Gerardo Sarno1 • Giuseppe Daniele2 • Giacomo Tirabassi9 • Alberto O. Chavez2 • Opeolu O. Ojo3 • Francesco Orio4,5 • Hana Kahleova6 • Giancarlo Balercia9 • William B. Grant7 • Paride De Rosa1 • Annamaria Colao8 • Giovanna Muscogiuri8
Received: 27 March 2015 / Accepted: 13 May 2015 Springer Science+Business Media New York 2015
Abstract Vitamin D deficiency is common among kidney transplant (KT) recipients because of reduced sunlight exposure, low intake of vitamin D, the immunosuppressive drug regimen administered, and steroid therapy. Glucocorticoids regulate expression of genes coding for enzymes that catabolize vitamin D, further reducing its level in serum. Although vitamin D primarily regulates calcium homeostasis, vitamin D deficiency is associated with the risk of several diseases, such as diabetes mellitus and tuberculosis. Aim of this review is to highlight endocrine and & Giovanna Muscogiuri [email protected] 1
Department of General Surgery and Transplantation Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Scuola Medica Salernitana, Salerno, Italy
2
Divisions of Diabetes and Endocrinology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
3
Faculty of Life and Health Sciences, School of Biomedical Sciences, University of Ulster, Coleraine BT52 1SA, UK
4
Sports Science and Wellness, University Parthenope Naples, Naples, Italy
5
Endocrinology and Diabetology, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Scuola Medica Salernitana, Salerno, Italy
6
Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
7
Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA
8
Department of Clinical Medicine and Surgery, Federico II University Hospital, Federico II University, Naples, Italy
9
Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, School of Medicine, Polytechnic University of Marche, Ancona, Italy
metabolic alterations due to the vitamin D deficiency by evaluating the mechanisms involved in the development of KT-related disease (cardiovascular, bone mineral density, and new-onset diabetes after transplantation). Next, we review evidence to support a link between low vitamin D status and KT-related diseases. Finally, we briefly highlight strategies for restoring vitamin D status in KT patients. Keywords Vitamin D Kidney transplantation New-onset diabetes after transplantation Cardiovascular disease Bone mineral density Malignancies
Introduction Vitamin D3 (cholecalciferol) is formed in the skin by photolysis of 7-dehydrocholesterol by ultraviolet radiation from sunlight. Cholecalciferol is transported in the bloodstream bound to vitamin D binding protein and is hydroxylated in the liver to 25-hydroxyvitamin D [25(OH)D or calcidiol]. In th
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