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Vitamin D deficiency and infection risk in kidney transplant recipients: A single‐center cohort study
Author(s) -
FernándezRuiz Mario,
Corbella Laura,
MoralesCartagena Alejandra,
González Esther,
Polanco Natalia,
RuizMerlo Tamara,
Parra Patricia,
Silva Jose T.,
LópezMedrano Francisco,
San Juan Rafael,
Aramendi Mercedes,
Andrés Amado,
Aguado José María
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12988
Subject(s) - medicine , vitamin d deficiency , vitamin d and neurology , hazard ratio , confidence interval , gastroenterology , immunosuppression , cohort , vitamin
Background Recent studies have reported an increased susceptibility to infection among vitamin D‐deficient kidney transplant ( KT ) recipients, although methodological concerns remain. Methods Serum 25‐hydroxyvitamin D (25( OH )D) levels were measured in 246 KT recipients at post‐transplant months 1, 3, 6 and 12. Vitamin D status was analysed in terms of deficiency (Endocrine Society [<20 ng/mL] and Institute of Medicine [IoM, <12 ng/mL] criteria) and as a continuous variable. Cox models for overall, bacterial and opportunistic infection were adjusted for nutritional status and immunosuppression‐related covariates. Results Median serum 25( OH )D increased from month 1 (10.5 ng/mL) to month 6 (16.3 ng/mL; P ‐value = 0.001). Prevalence of vitamin D deficiency at month 1 ranged from 87.0% to 61.0% (depending on the diagnostic criteria) and significantly decreased over the next months. After adjustment for age and nutritional status, vitamin D deficiency (serum 25( OH )D < 12 ng/mL) at month 1 was an independent risk factor for overall (hazard ratio [ HR ]: 1.70; 95% confidence interval [ CI ]: 1.08‐2.69; P ‐value = 0.023) and opportunistic infection ( HR : 4.05; 95% CI : 1.57‐10.46; P ‐value = 0.004), but not for bacterial infection. A protective effect for overall (adjusted HR : 0.76; 95% CI : 0.63‐0.93; P ‐value = 0.007) and opportunistic infection (adjusted HR : 0.62; 95% CI : 0.45‐0.86; P ‐value = 0.004) was observed when 25( OH )D levels were analyzed per one‐quartile increases. Conclusions Vitamin D status influences the risk of infection among KT recipients, with the association being particularly evident for opportunistic events and mainly restricted to the early post‐transplant period.