Nephrology Dialysis, Clinique du Landy, Saint Ouen, France.
Am J Kidney Dis. 2011 Oct;58(4):544-53. doi: 10.1053/j.ajkd.2011.04.029. Epub 2011 Jul 31.
Vitamin D (25 hydroxyvitamin D [25(OH)D]) deficiency is common in patients with chronic kidney disease (CKD). Neither the relation of this deficiency to the decrease in glomerular filtration rate (GFR) nor the effects on CKD mineral and bone disorders (MBD) are clearly established.
Cross-sectional analysis of baseline data from a prospective cohort, the NephroTest Study.
SETTING & PARTICIPANTS: 1,026 adult patients with all-stage CKD not on dialysis therapy or receiving vitamin D supplementation.
For part 1, measured GFR (mGFR) using (51)Cr-EDTA renal clearance; for part 2, 25(OH)D deficiency at <15 ng/mL.
OUTCOMES & MEASUREMENTS: For part 1, 25(OH)D deficiency and several circulating MBD markers; for part 2, circulating MBD markers.
For part 1, the prevalence of 25(OH)D deficiency was associated inversely with mGFR, ranging from 28%-51% for mGFR ≥60-<15 mL/min/1.73 m(2). It was higher in patients of African origin; those with obesity, diabetes, hypertension, macroalbuminuria, and hypoalbuminemia; and during winter. After adjusting for these factors, ORs for 25(OH)D deficiency increased from 1.4 (95% CI, 0.9-2.3) to 1.4 (95% CI, 0.9-2.1), 1.7 (95% CI, 1.1-2.7), and 1.9 (95% CI, 1.1-3.6) as mGFR decreased from 45-59 to 30-44, 15-29, and <15 (reference, ≥60) mL/min/1.73 m(2) (P for trend = 0.02). For part 2, 25(OH)D deficiency was associated with higher age-, sex-, and mGFR-adjusted ORs of ionized calcium level <1.10 mmol/L (2.6; 95% CI, 1.2-5.9), 1,25 dihydroxyvitamin D concentration <16.7 pg/mL (1.8; 95% CI, 1.3-2.4), hyperparathyroidism (1.8; 95% CI, 1.3-2.4), and serum C-terminal cross-linked collagen type I telopeptides concentration >1,000 pg/mL (1.6; 95% CI, 1.0-2.6). It was not associated with hyperphosphatemia (phosphate >1.38 mmol/L).
Cross-sectional analysis of the data prevents causal inferences.
25(OH)D deficiency is related independently to impaired mGFR. Both mGFR decrease and 25(OH)D deficiency are associated with abnormal levels of circulating MBD biomarkers.
维生素 D（25 羟维生素 D [25(OH)D]）缺乏在慢性肾脏病（CKD）患者中很常见。这种缺乏与肾小球滤过率（GFR）下降的关系，以及对 CKD 矿物质和骨代谢紊乱（MBD）的影响都尚未明确。
前瞻性队列研究——NephroTest 研究的基线数据的横断面分析。
1026 例各期 CKD 患者，未接受透析治疗或正在接受维生素 D 补充治疗。
第 1 部分，用（51）Cr-EDTA 肾清除率测量肾小球滤过率（mGFR）；第 2 部分，25(OH)D 缺乏<15ng/ml。
第 1 部分，25(OH)D 缺乏和几种循环 MBD 标志物；第 2 部分，循环 MBD 标志物。
第 1 部分，25(OH)D 缺乏的患病率与 mGFR 呈负相关，mGFR≥60-<15ml/min/1.73m2 时，25(OH)D 缺乏的患病率为 28%-51%。25(OH)D 缺乏在非裔美国人患者中更为常见；在肥胖、糖尿病、高血压、大量蛋白尿和低白蛋白血症患者中更常见；并且在冬季更常见。在调整了这些因素后，mGFR 从 45-59 降至 30-44、15-29 和<15（参考值，≥60）ml/min/1.73m2 时，25(OH)D 缺乏的 OR 分别从 1.4（95%CI，0.9-2.3）增加至 1.4（95%CI，0.9-2.1）、1.7（95%CI，1.1-2.7）和 1.9（95%CI，1.1-3.6）（P 趋势=0.02）。第 2 部分，25(OH)D 缺乏与校正年龄、性别和 mGFR 后离子钙水平<1.10mmol/L（2.6；95%CI，1.2-5.9）、1,25 二羟维生素 D 浓度<16.7pg/ml（1.8；95%CI，1.3-2.4）、甲状旁腺功能亢进症（1.8；95%CI，1.3-2.4）和血清 C 端交联型胶原 I 肽浓度>1000pg/ml（1.6；95%CI，1.0-2.6）的校正后比值比更高。25(OH)D 缺乏与高磷血症（磷>1.38mmol/L）无关。
对数据的横断面分析限制了因果关系的推断。
25(OH)D 缺乏与 mGFR 受损独立相关。mGFR 下降和 25(OH)D 缺乏均与循环 MBD 生物标志物水平异常相关。
