Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Relationship between vitamin D and post-transplant diabetes mellitus in kidney transplant recipients
Dhiraj Singh, Sukhwinder S Sangha, Raj K Yadav, Arun K Subbiah, Sushma Yadav, Asheesh Kumar, Rajesh Khadgawat, Pradeep K Chaturvedi, Sanjay K Agarwal, Sandeep Mahajan, Taruna Pahuja, Dipankar Bhowmik
Dhiraj Singh, Department of Nephrology, Globe Health Care, Nirala Nagar, Lucknow 226020, Uttar Pradesh, India
Sukhwinder S Sangha, Department of Nephrology, Command Hospital Chandimandir, Panchkula 134107, Haryāna, India
Raj K Yadav, Arun K Subbiah, Sanjay K Agarwal, Sandeep Mahajan, Taruna Pahuja, Dipankar Bhowmik, Department of Nephrology, AIIMS, New Delhi 110029, Delhi, India
Sushma Yadav, Department of Gynecology, SHKM GMC, Nuh 122107, Haryana, India
Asheesh Kumar, Department of Nephrology, AIIMS, Vijaypur, Jammu 184120, Jammu and Kashmir, India
Rajesh Khadgawat, Department of Endocrinology and Metabolism, AIIMS, New Delhi 110029, Delhi, India
Pradeep K Chaturvedi, Department of Reproductive Biology, AIIMS, New Delhi 110029, Delhi, India
Co-first authors: Dhiraj Singh and Sukhwinder S Sangha.
Author contributions: Singh D, Sangha SS, and Yadav RK contributed to conceptualization and the original manuscript draft; Singh D, Sangha SS, Yadav RK, Subbiah AK, Yadav S, Kumar A, Khadgawat R, and Chaturvedi PK contributed to data curation and methodology; Singh D, Sangha SS, Yadav RK, and Pahuja T contributed to formal analysis and funding acquisition; Singh D and Sangha SS contributed equally to this manuscript as co-first authors; Yadav RK, Agarwal SK, Mahajan S, and Bhowmik D contributed to supervision; Sangha SS, Yadav RK, Agarwal SK, Mahajan S, and Bhowmik D reviewed and edited the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the All India Institute of Medical Sciences, New Delhi, Institutional Review Board (approve No. IECPG-534/29.08.2019).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
rkyadavnephrology@gmail.com. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Raj K Yadav, Additional Professor, DM, FASN, Department of Nephrology, AIIMS, Ansari Nagar, New Delhi 110029, Delhi, India.
rkyadavnephrology@gmail.com
Received: August 22, 2025
Revised: September 13, 2025
Accepted: November 28, 2025
Published online: December 25, 2025
Processing time: 123 Days and 19 Hours
BACKGROUND
Post-transplant diabetes mellitus (PTDM) adversely affects graft survival and is an independent predictor of adverse cardiovascular events. Observational studies in the general population as well as the post-transplant setting suggest an association between the plasma 25-hydroxyvitamin D [25(OH)D] level and onset of type 2 diabetes mellitus. Literature is very limited in the context of PTDM.
AIM
To study the relationship between vitamin D deficiency at the time of kidney transplant and PTDM in the post-transplant period.
METHODS
In this single center study, 72 patients who underwent kidney transplant were included. Blood samples for serum vitamin D level were collected on the day of transplant and analyzed at the end of study. The LIAISON® 25(OH)D assay was used for quantitative estimation of total 25(OH)D in the serum. PTDM was diagnosed by either fasting plasma glucose (> 126 mg/dL), 2-h post prandial plasma glucose (> 200 mg/dL), or 2-h oral glucose tolerance test after 45 days post-transplant. Hemoglobin A1c was not used to diagnose PTDM. Vitamin D levels were labeled as sufficient (≥ 30.0 ng/mL), insufficient (20.0-29.9 ng/mL), and deficient (< 20.0 ng/mL). Patients were reviewed at 45 days and 1 year post transplant for the occurrence of PTDM.
RESULTS
In our study cohort 72 patients completed the study. Overall, 32 (43.8%) patients developed PTDM during the follow up of 1 year, 44 (61.1%) patients had deficient (< 20 ng/mL) 25(OH)D levels. Twenty-six (81.2%) patients with PTDM had deficient vitamin D levels as compared with 18 (45.0%) patients without PTDM (P = 0.007). This association was also significant when univariable [odds ratio (OR) = 5.3, 95% confidence interval (CI): 1.79-15.67, P = 0.003)] and multivariable (OR = 8.21, 95%CI: 2.19-30.75, P = 0.002) regression analysis was performed. A higher proportion of subjects having PTDM (15.6%) had a positive family history of diabetes mellitus than the controls (2.5%) (P = 0.045). However, this association did not persist in the multivariable regression analysis (OR = 12.6, 95%CI: 0.86-185.4, P = 0.065).
CONCLUSION
Deficient vitamin D levels (< 20 ng/mL) were significantly associated with PTDM in the post kidney transplant setting. Further studies are needed to see the effect of vitamin D replacement on PTDM.
Core Tip: In this study a significant number of patients who underwent kidney transplant developed post-transplant diabetes mellitus (PTDM) in the 1-year follow up. This is the first study from a tropical region showing a statistically significant association of vitamin D deficiency and PTDM. This finding is important since PTDM adversely affects graft survival and is an independent predictor of adverse cardiovascular events. It will be interesting to study the effect of vitamin D replacement on PTDM to potentially reduce the morbidity associated with PTDM.
