García-Cantón C, Bosch E, Auyanet I, Ramírez A, Rossique P, Culebras C, Sánchez A, Toledo A, Lago M, Esparza Noemí, Checa María Dolores
Servicio de Nefrología, Hospital Universitario Insular de Gran Canaria.
Nefrologia. 2010;30(4):435-42. doi: 10.3265/Nefrologia.pre2010.Mar.10288.
Decreased 25 hydroxyvitamin D serum levels have been related to an increase in cardiovascular morbility and mortality in both general population and chronic kidney disease patients. The aim of this study was to evaluate the relationship between 25 hydroxyvitamin D serum level, cardiovascular risk factors and previous established cardiovascular disease in a group of patients with advanced chronic kidney disease.
We performed a cross-sectional observational study in a cohort of 171 stage 4 and 5 chronic kidney disease outpatients seen in our predialysis clinic, mean age 64.16 +/- 13 years, 59.6% were men, 64.3% had diabetes, 47.3% had obesity, 46.8% had previous cardiovascular disease. 25 hydroxyvitamin D and 1-25 dihydroxyvitamin D were measured, we also determined other routine biochemical parameters. All subjects underwent an echocardiogram and 24 hours ambulatory blood pressure monitoring was also performed.
Mean 25 hydroxyvitamin D levels were 22.1 +/- 13 ng/mL, only 18.7% of the patients had adequate levels, levels were insufficient in 58.5% of the patients and deficient in 22.8% of them. Low 25 hydroxyvitamin D levels were significantly related with age, diabetes, female gender, obesity, MDRD glomerular filtration rate and previous cardiovascular disease. Pulse pressure was the Ambulatory Blood Pressure Monitoring parameter that was better correlated with 25 hydroxyvitamin D levels. We could not find any association between vitamin D levels and other bone and mineral metabolism parameters. No relationship was seen between low vitamin D levels and left ventricular hypertrophy. On multivariate analysis lower levels of 25 hydroxyvitamin D were independently associated with female gender, previous cardiovascular disease, MDRD4-GFR and higher pulse pressure.
Our study confirm a high prevalence of 25 hydroxyvitamin D insufficiency and deficiency in advanced chronic kidney disease patients, this was associated with the presence of cardiovascular risk markers and previous established cardiovascular disease. However we could not see any relationship with left ventricular hypertrophy which is a known predictor of future cardiovascular events in this population.
血清25羟维生素D水平降低与普通人群及慢性肾脏病患者心血管发病率和死亡率增加有关。本研究旨在评估一组晚期慢性肾脏病患者的血清25羟维生素D水平、心血管危险因素与既往确诊的心血管疾病之间的关系。
我们对171例在我院透析前门诊就诊的4期和5期慢性肾脏病门诊患者进行了一项横断面观察性研究，平均年龄64.16±13岁，59.6%为男性，64.3%患有糖尿病，47.3%患有肥胖症，46.8%既往有心血管疾病。检测了25羟维生素D和1,25二羟维生素D，还测定了其他常规生化参数。所有受试者均接受了超声心动图检查，并进行了24小时动态血压监测。
25羟维生素D平均水平为22.1±13 ng/mL，只有18.7%的患者水平充足，58.5%的患者水平不足，22.8%的患者水平缺乏。低25羟维生素D水平与年龄、糖尿病、女性、肥胖、MDRD肾小球滤过率及既往心血管疾病显著相关。脉压是动态血压监测参数中与25羟维生素D水平相关性最好的指标。我们未发现维生素D水平与其他骨和矿物质代谢参数之间存在任何关联。低维生素D水平与左心室肥厚之间未见相关性。多因素分析显示，较低的25羟维生素D水平与女性、既往心血管疾病、MDRD4-GFR及较高脉压独立相关。
我们的研究证实晚期慢性肾脏病患者中25羟维生素D不足和缺乏的患病率较高，这与心血管风险标志物的存在及既往确诊的心血管疾病有关。然而，我们未发现其与左心室肥厚存在任何关系，而左心室肥厚是该人群未来心血管事件的已知预测指标。
Zotero 插件