Fibroblast growth factor-23, vitamin D and mineral metabolism in renal transplant recipients

In CKD patients various disturbances in vitamin D metabolism in addition to their classical effects on mineral bone disorder (MBD), also can have important effects on innate or adaptive immunity through various signaling pathways. Vitamin D deficiency could be a factor for triggering rejection, chronic allograft nephropathy and infections in post-transplant period. Patients with CKD are known to be both 25-hydroxyvitamin D (25OHD3) and 1,25-dihydroxyvitamin D (1,25[OH]2D3) deficient. Several observational studies have shown that treatment of ESRD patients with vitamin D analogues is associated with improved survival. 1,25(OH)2-D3 has long been recognized to have an immune regulatory function besides its role in calcium homeostasis. There is evidence in literature that indicates that 1,25(OH)2-D3 could have an important role in the regulation of immune function. This could have important clinical implications. Transplant physicians and surgeons should understand that vitamin D has a variety of immunological actions which can have important effect on patient and graft survival after transplantation.