Department of Medicine, University of Washington, Seattle, WA 98195, USA. Tele
Clin J Am Soc Nephrol. 2011 Sep;6(9):2141-9. doi: 10.2215/CJN.02640311. Epub 2011 Aug 11.
Mounting evidence suggests that 1,25-dihydroxyvitamin D prevents the progression of chronic kidney disease (CKD). It is not clear whether "nutritional" forms of vitamin D affect GFR.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We tested whether serum 25-hydroxyvitamin D concentration (25(OH)D), a measure of total vitamin D intake from cutaneous synthesis and dietary consumption, is associated with loss of estimated GFR among 1705 older adults with predominantly normal baseline kidney function participating in the Cardiovascular Health Study. Baseline 25(OH)D was measured by HPLC-tandem mass spectrometry. GFR was estimated at baseline and 4 years later using the CKD-EPI formula, with rapid GFR loss defined as 12 ml/min per 1.73 m(2) or more over 4 years.
Rapid GFR loss was observed for 207 participants (12%). Each 10 ng/ml lower 25(OH)D was associated with a 25% greater risk of rapid GFR loss (95% confidence interval [CI] 5%, 49%, P = 0.01), adjusting for potential confounding characteristics. Compared with 25(OH)D ≥30 ng/ml, 25(OH)D concentrations 15 to 29 ng/ml and <15 ng/ml were associated with 29% (95% CI -13%, 91%) and 68% (95% CI 1%, 177%) greater adjusted risks of rapid GFR loss, respectively. Magnitudes of association were largest among participants with diabetes.
were similar evaluating a composite outcome of rapid GFR loss, end stage renal disease, and death. Conclusions Insufficient 25(OH)D may be a modifiable risk factor for early GFR loss. We recommend clinical trials to determine whether vitamin D supplementation prevents the development and progression of CKD.
越来越多的证据表明 1,25-二羟维生素 D 可阻止慢性肾脏病（CKD）的进展。目前尚不清楚“营养”形式的维生素 D 是否会影响肾小球滤过率（GFR）。
设计、设置、参与者和测量方法：我们检测了血清 25-羟维生素 D 浓度（25（OH）D），这是衡量皮肤合成和饮食摄入的总维生素 D 摄入量的指标，与参加心血管健康研究的 1705 名肾功能基本正常的老年人中估计的 GFR 丧失是否相关。使用 HPLC-串联质谱法测量基线 25（OH）D。使用 CKD-EPI 公式在基线和 4 年后估计 GFR，快速 GFR 损失定义为 4 年内 1.73m2 以上每分钟 12ml/min。
207 名参与者（12%）出现快速 GFR 损失。25（OH）D 每降低 10ng/ml，快速 GFR 损失的风险增加 25%（95%置信区间 [CI] 5%，49%，P = 0.01），调整了潜在的混杂特征。与 25（OH）D≥30ng/ml 相比，25（OH）D 浓度 15-29ng/ml 和<15ng/ml 分别与调整后的快速 GFR 损失风险增加 29%（95% CI -13%，91%）和 68%（95% CI 1%，177%）相关。在糖尿病患者中，关联的幅度最大。
在评估快速 GFR 损失、终末期肾病和死亡的复合结局时，结果相似。结论：维生素 D 不足可能是早期 GFR 丧失的一个可改变的危险因素。我们建议进行临床试验，以确定维生素 D 补充是否可以预防 CKD 的发生和进展。
