DOI: 10.4103/ijkd.ijkd_30_26 ISSN: 2950-0761

Therapeutic Role of Vitamin D Supplementation on Bone Mineral Density and Graft Outcomes in Kidney Transplant Recipients: A Randomized Controlled Trial

Abhijit Konnur, Sishir Gang, Umapati Hegde, Hardik Patel, Harshkumar A. Patel, Nitiraj Shete
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BSTRACT

Background:

Vitamin D deficiency is common among kidney transplant recipients and may affect bone mineral density (BMD) and graft outcomes. This study evaluated the effects of two doses of 25-hydroxyvitamin D (25(OH)D) supplementation on BMD, mineral metabolism, and graft function.

Methods:

This prospective, open-label, randomized controlled trial enrolled 49 live-donor kidney transplant recipients with baseline 25(OH)D levels <30 ng/mL at a quaternary-care nephrology centre in India, from July 2023 to June 2024. Participants were randomized to standard-dose (60,000 IU/week for 8 weeks, then monthly for 10 months; n = 24) or low-dose (30,000 IU/week for 8 weeks, then monthly, for ten months; n = 25) 25(OH)D. Assessments included serum 25(OH)D, parathyroid hormone (PTH), calcium, phosphorus, BMD (femoral neck and lumbar spine via dual-energy X-ray absorptiometry), FRAX-score, estimated glomerular filtration rate (eGFR), and serum creatinine at baseline, 3, 6, and 12 months. Intention-to-treat analysis was performed using independent t -tests ( P < 0.05; significant).

Results:

Baseline characteristics were similar between groups. Standard-dose group achieved significantly higher 25(OH)D levels at 3-months (39.43 ± 5.27 vs. 32.33 ± 4.69 ng/mL; P < 0.001), 6-months (36.17 ± 3.99 vs. 30.09 ± 3.67; P < 0.001), and 12-months (32.27 ± 2.62 vs. 29.16 ± 4.64; P = 0.006). PTH declined similarly in both groups (90.8 ± 22.4 vs. 86.6 ± 25.5 pg/mL at 12-months; P = 0.215). Femoral neck BMD improved more in the standard-dose group at 12-months (0.78 ± 0.04 vs. 0.75 ± 0.06 g/cm 2 ; P = 0.045). Lumbar Z-score was better in the standard-dose group at 12-months (−1.01 ± 0.33 vs. −1.24 ± 0.47; P = 0.048). FRAX scores decreased modestly without intergroup differences. eGFR and creatinine were stable and similar between groups. No hypercalcemia, fractures, or Vitamin D toxicity occurred.

Conclusions:

Kidney transplantation significantly improves mineral metabolism and bone parameters within the 1 st year. Furthermore, standard Vitamin D supplementation led to higher circulating levels and better femoral neck BMD than lower-dose regimens, with no significant differences in renal allograft function or metabolic outcomes.

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