Association Between Post-Transplant Vitamin D, Metabolic Syndrome, and Post Transplant Diabetes Mellitus
.Kidney360 ():10.34067/KID.0000000763, March 07, 2025. | DOI: 10.34067/KID.0000000763
Malyala, Rohit1,†; Vansjalia, Karan1; Nash, Michelle1; Dacouris, Niki1; Rapi, Lindita1; Prasad, G.V. Ramesh1,2
Background:
Associations between 25-hydroxyvitamin D (25(OH)D) deficiency and diabetes have been observed in the general population, but are less delineated in kidney transplant recipients (KTR), especially in the context of highly-prevalent metabolic syndrome (MetS) features in KTR. We hypothesized that vitamin D deficiency may present greater risk in KTR in those with greater burden of MetS features.
Methods:
We retrospectively evaluated 1792 KTR with no treated diabetes at transplant between 1998 and 2018. Vitamin D was measured at ≥3 months post transplant. MetS features were defined by National Cholesterol Education Program, Adult Treatment Panel III (NCEP-ATP III) criteria. The primary outcome was treated post-transplant diabetes mellitus (PTDM) incidence.
Results:
In 1792 non-diabetic KTR followed for 10956 patient-years, 237 patients developed PTDM.
For KTR meeting NCEP-ATP-III criteria, with
- 4th-quartile 25(OH)D, there were 1.5 new diagnoses per 100 patient-years, versus
- 4.2 events per 100 patient-years in KTR with 1st-quartile 25(OH)D (p<0.001).
In multivariate survival regression, vitamin D was, accounting for individual NCEP-ATP-III criteria, associated with PTDM (HR 0.93 per 10 nmol/mL 25(OH)D, p=0.007) independently of fasting blood sugar and HbA1c. In marginal effects analysis, MetS impact on PTDM increased as serum 25(OH)D levels decreased.
Conclusions:
Our study suggests that decreased 25(OH)D is associated with increased PTDM, and this marginal impact worsens as KTR have an increased burden of MetS.
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See related in VitaminDWiki
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- Kidney transplant rejection 1.8X more likely if low vitamin D – May 2021
- Vitamin D would probably help both CKD and Kidney transplant (PDF behind paywall) – Sept 2024
- Metformin appears to activate the Vitamin D Receptor (more D to kidney cells, etc,) - March 2025