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 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.

Department of Clinical Medicine and Surgery Federico 2 University Hospital Federico 2 University Naples Italy

Department of General Surgery and Transplantation Unit San Giovanni di Dio e Ruggi D'Aragona University Hospital Scuola Medica Salernitana Salerno Italy

Division of Endocrinology Department of Clinical and Molecular Sciences Umberto 1 Hospital School of Medicine Polytechnic University of Marche Ancona Italy

Divisions of Diabetes and Endocrinology Department of Medicine University of Texas Health Science Center at San Antonio San Antonio TX USA

Endocrinology and Diabetology San Giovanni di Dio e Ruggi D'Aragona University Hospital Scuola Medica Salernitana Salerno Italy

Faculty of Life and Health Sciences School of Biomedical Sciences University of Ulster Coleraine BT52 1SA UK

Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

Sports Science and Wellness University Parthenope Naples Naples Italy

Sunlight Nutrition and Health Research Center San Francisco CA USA

See more in PubMed

Kidney Int. 2009 Mar;75(6):646-51 PubMed

Endocrinology. 1994 Apr;134(4):1602-10 PubMed

Am J Cardiol. 2012 Feb 1;109(3):359-63 PubMed

Am J Transplant. 2014 Jun;14(6):1259-70 PubMed

Endocrine. 2014 May;46(1):29-38 PubMed

J Am Soc Nephrol. 2002 Jun;13(6):1608-14 PubMed

Cancer Prev Res (Phila). 2012 Oct;5(10):1229-35 PubMed

Clin Transplant. 2007 Nov-Dec;21(6):683-8 PubMed

Am J Nephrol. 2011;34(1):87-94 PubMed

Kidney Int. 2010 Feb;77(4):299-311 PubMed

Eur J Clin Nutr. 2014 Feb;68(2):196-202 PubMed

Transplantation. 2003 Nov 27;76(10 ):1498-502 PubMed

Transplantation. 2005 Jan 15;79(1):108-15 PubMed

Transplant Proc. 2000 May;32(3):556-7 PubMed

Semin Nephrol. 2013 Mar;33(2):158-68 PubMed

J Clin Invest. 2005 Jan;115(1):177-86 PubMed

Diabetes Metab Syndr Obes. 2011;4:175-86 PubMed

Clin Biochem Rev. 2005 Feb;26(1):33-6 PubMed

Transplant Proc. 2010 Oct;42(8):2917-20 PubMed

Circulation. 2005 Apr 5;111(13):1666-71 PubMed

Ann Intern Med. 2010 Mar 2;152(5):315-23 PubMed

Transplantation. 2010 Jan 27;89(2):131-7 PubMed

N Engl J Med. 1991 Aug 22;325(8):544-50 PubMed

Endocrine. 2014 Mar;45(2):319-24 PubMed

Transplantation. 2006 Sep 15;82(5):603-11 PubMed

Endocrine. 2015 Jun;49(2):521-7 PubMed

Hypertension. 2011 Jan;57(1):63-9 PubMed

Syst Rev. 2014 Jun 14;3:64 PubMed

Endocrine. 2013 Feb;43(1):230-2 PubMed

Kidney Int. 2000 Feb;57(2):735-7 PubMed

Transplant Proc. 1996 Dec;28(6):3485-7 PubMed

Expert Rev Clin Immunol. 2014 Oct;10(10):1375-83 PubMed

Transplantation. 2008 Mar 15;85(5):767-70 PubMed

J Am Soc Nephrol. 2003 Nov;14(11):2975-9 PubMed

J Clin Endocrinol Metab. 2015 Jan;100(1):81-9 PubMed

Trials. 2014 Nov 06;15:430 PubMed

Kidney Int Suppl. 2002 May;(80):78-84 PubMed

Miner Electrolyte Metab. 1988;14(6):332-7 PubMed

Eur J Clin Nutr. 2015 Mar;69(3):291-6 PubMed

Clin J Am Soc Nephrol. 2006 Nov;1(6):1300-13 PubMed

Trials. 2009 May 29;10:36 PubMed

Clin Transplant. 2004 Oct;18(5):596-604 PubMed

Endocrine. 2014 Dec;47(3):854-61 PubMed

Clin Biochem. 2014 May;47(7-8):509-15 PubMed

Int J Prev Med. 2014 Sep;5(9):1091-8 PubMed

Transplantation. 2012 Jun 27;93(12):1189-95 PubMed

Curr Diabetes Rev. 2013 Jan 1;9(1):78-85 PubMed

Am J Nephrol. 2004 Sep-Oct;24(5):503-10 PubMed

Int Urol Nephrol. 2006;38(2):323-9 PubMed

Kidney Int. 2009 Mar;75(6):576-8 PubMed

Nucl Med Commun. 2015 May;36(5):489-93 PubMed

Kidney Int. 2004 Feb;65(2):705-12 PubMed

Am J Transplant. 2007 Nov;7(11):2546-52 PubMed

Endocr Pract. 2012 Jul-Aug;18(4):579-90 PubMed

Endocrine. 2014 Sep;47(1):70-80 PubMed

Minerva Endocrinol. 2012 Sep;37(3):233-46 PubMed

Kidney Int. 2005 May;67(5):2039-45 PubMed

Circulation. 2008 Jan 29;117(4):503-11 PubMed