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. 2024 Dec 13;12(12):2588.
doi: 10.3390/microorganisms12122588.

Low 25-Hydroxyvitamin D Post-Kidney Transplant Is Associated with Increased Risk of BK Polyomavirus-Associated Nephropathy

Suseela A Raj  1 , Angela L Zhou  1 , Ekaterina Fedorova  2 , Zhongyu Yuan  1   3 , Didier A Mandelbrot  1 , Brad C Astor  1   3 , Sandesh Parajuli  1
Affiliations

Low 25-Hydroxyvitamin D Post-Kidney Transplant Is Associated with Increased Risk of BK Polyomavirus-Associated Nephropathy

Suseela A Raj et al. Microorganisms. .

Abstract

BK viremia (BKPyV-DNAemia) and nephropathy (BKPyVAN) are significant causes of morbidity and mortality in kidney transplant recipients (KTRs). Vitamin D supports immune function, yet low 25-hydroxyvitamin D [25(OH)D] is common among KTRs. The association between serum 25(OH)D, measured 61 days to 2 years post-transplant, and subsequent incident BKPyV-DNAemia and BKPyVAN was examined in KTRs without previous BKPyV-DNAemia or BKPyVAN, respectively. Out of 3308 KTRs, 399 (12%) were vitamin D deficient [25(OH)D ≤ 20 ng/mL], and 916 (27.7%) were insufficient [25(OH)D 21-29 ng/mL]. A total of 184 KTRs developed BKPyV-DNAemia and 44 developed BKPyVAN. The incidence rate (/100 person-years) for BKPyV-DNAemia was 2.88 in the 25(OH)D sufficient group, 2.22 in the insufficient group, and 2.37 in the deficient group. The incidence rate (/100 person-years) for BKPyVAN was 0.30 in the 25(OH)D sufficient group, 0.75 in the insufficient group, and 1.28 in the deficient group. Vitamin D deficiency (adjusted hazard ratio [aHR] compared to 25(OH)D sufficiency: 3.92; 95% CI: 1.66-9.23) and insufficiency (aHR: 2.22; 95% CI: 1.11-4.45) remained significantly associated with the incidence of BKPyVAN after adjustment for baseline characteristics. Low serum 25(OH)D was associated with an increased risk of BKPyVAN but not BKPyV-DNAemia.

Keywords: BK virus; kidney transplants; vitamin D.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Process of inclusion and exclusion from analyses. 25(OH)D, 25-hydroxyvitamin D; BKPyV-DNAemia, BK viremia; BKPyVAN, BK nephropathy.
Figure 2
Figure 2
Adjusted incidence rate ratio for BKPyV-DNAemia, by 25(OH)D level. No significant association of BKPyV-DNAemia with 25(OH)D levels. 25(OH)D, 25-hydroxyvitamin D; BKPyV-DNAemia, BK viremia.
Figure 3
Figure 3
Adjusted incidence rate ratio for BKPyVAN, by 25(OH)D level. The incidence of BKPyVAN was higher with a lower 25(OH)D level. 25(OH)D, 25-hydroxyvitamin D; BKPyVAN, BK nephropathy.
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