{"doi":"10.1093/ndt/gfad168","title":"Epimeric vitamin D and cardiovascular structure and function in advanced CKD and after kidney transplantation","abstract":"BACKGROUND: 25-hydroxyvitamin D can undergo C-3 epimerization to produce 3-epi-25(OH)D3. 3-epi-25(OH)D3 levels decline in chronic kidney disease (CKD), but its role in regulating the cardiovascular system is unknown. Herein, we examined the relationship between 3-epi-25(OH)D3, and cardiovascular functional and structural endpoints in patients with CKD. METHODS: We examined n = 165 patients with advanced CKD from the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) study cohort, including those who underwent kidney transplant (KTR, n = 76) and waitlisted patients who did not (NTWC, n = 89). All patients underwent cardiopulmonary exercise testing and echocardiography at baseline, 2 months and 12 months. Serum 3-epi-25(OH)D3 was analyzed by liquid chromatography-tandem mass spectrometry. RESULTS: Patients were stratified into quartiles of baseline 3-epi-25(OH)D3 (Q1: <0.4 ng/mL, n = 51; Q2: 0.4 ng/mL, n = 26; Q3: 0.5-0.7 ng/mL, n = 47; Q4: ≥0.8 ng/mL, n = 41). Patients in Q1 exhibited lower peak oxygen uptake [VO2Peak = 18.4 (16.2-20.8) mL/min/kg] compared with Q4 [20.8 (18.6-23.2) mL/min/kg; P = .009]. Linear mixed regression model showed that 3-epi-25(OH)D3 levels increased in KTR [from 0.47 (0.30) ng/mL to 0.90 (0.45) ng/mL] and declined in NTWC [from 0.61 (0.32) ng/mL to 0.45 (0.29) ng/mL; P < .001]. Serum 3-epi-25(OH)D3 was associated with VO2Peak longitudinally in both groups [KTR: β (standard error) = 2.53 (0.56), P < .001; NTWC: 2.73 (0.70), P < .001], but was not with left ventricular mass or arterial stiffness. Non-epimeric 25(OH)D3, 24,25(OH)2D3 and the 25(OH)D3:24,25(OH)2D3 ratio were not associated with any cardiovascular outcome (all P > .05). CONCLUSIONS: Changes in 3-epi-25(OH)D3 levels may regulate cardiovascular functional capacity in patients with advanced CKD.","journal":"Nephrology Dialysis Transplantation","year":2023,"id":351428,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9487,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1069764,"name":"Cecilia A. Leber","orcid":"0000-0001-8890-9531","position":1,"is_corresponding":false},{"id":942689,"name":"Heather Burney","orcid":null,"position":2,"is_corresponding":false},{"id":28483,"name":"Yang Li","orcid":"0000-0003-4022-7341","position":3,"is_corresponding":false},{"id":430677,"name":"Xiaochun Li","orcid":"0000-0002-1547-3041","position":4,"is_corresponding":false},{"id":314191,"name":"Tzongshi Lu","orcid":"0000-0002-3115-5000","position":5,"is_corresponding":false},{"id":337276,"name":"Glenville Jones","orcid":"0000-0001-7402-3473","position":6,"is_corresponding":false},{"id":337266,"name":"Martin Kaufmann","orcid":"0000-0003-0163-2205","position":7,"is_corresponding":false},{"id":942691,"name":"Stephen Ting","orcid":null,"position":8,"is_corresponding":false},{"id":273069,"name":"Thomas F. Hiemstra","orcid":null,"position":9,"is_corresponding":false},{"id":452651,"name":"Daniel Zehnder","orcid":"0000-0003-1356-2232","position":10,"is_corresponding":false},{"id":364820,"name":"Kenneth Lim","orcid":"0000-0001-7178-2183","position":11,"is_corresponding":false},{"id":896339,"name":"Eliott Arroyo","orcid":"0000-0001-7008-763X","position":0,"is_corresponding":true}],"reference_count":57,"raw_metadata":null,"created_at":"2026-07-19T01:12:41.740237Z","pmid":"37468453","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}