Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
J Ren Nutr. 2014 Jan;24(1):20-5. doi: 10.1053/j.jrn.2013.07.003. Epub 2013 Nov 8.
We aimed to evaluate the vitamin D status, the effect of cholecalciferol supplementation, and the factors associated with vitamin D restoration in nondialytic patients with chronic kidney disease (CKD).
The present study was a prospective open-label trial.
This study took place at the Seoul National University Boramae Medical Center.
Patients with nondialytic CKD (estimated glomerular filtration rate [eGFR] 10-59 mL/min per 1.73 m(2)) participated in this study.
Vitamin D status in 210 CKD patients was assessed and the patients with vitamin D deficiency (<30 ng/mL) were administered cholecalciferol (1,000 IU/day) for 6 months.
The restoration rate of vitamin D deficiency at 3 and 6 months and the response-related factors were analyzed.
The prevalence of vitamin D deficiency was 40.7% in CKD Stage 3, 61.5% in Stage 4, and 85.7% in Stage 5. The subgroup with vitamin D deficiency had a greater proportion of patients with diabetes, lower eGFR, and higher proteinuria. With the supplementation, 52 patients (76.5%) reached levels of 25-hydroxy vitamin D (25(OH)D) of 30 ng/mL or greater at 3 months, and the restoration of vitamin D was observed in 61 patients (89.7%) at 6 months. Lower levels of 25(OH)D and a higher amount of proteinuria at baseline were the factors associated with lower response to vitamin D supplementation.
Vitamin D deficiency rate was high in nondialytic CKD patients, and the proportion increased as renal function decreased. A higher amount of proteinuria was the independent risk factor of nonresponse with supplementation. Vitamin D was replenished in most patients with cholecalciferol supplementation without any significant adverse effects.
评估非透析慢性肾脏病（CKD）患者的维生素 D 状态、胆钙化醇补充的效果，以及与维生素 D 恢复相关的因素。
本研究为前瞻性开放标签试验。
本研究在首尔国立大学盆唐医疗中心进行。
参与本研究的患者为非透析性 CKD 患者（估计肾小球滤过率[eGFR]为 10-59mL/min/1.73m²）。
评估 210 例 CKD 患者的维生素 D 状态，维生素 D 缺乏症（<30ng/mL）患者接受胆钙化醇（1000IU/天）治疗 6 个月。
分析 3 个月和 6 个月时维生素 D 缺乏症的恢复率及相关反应因素。
CKD 3 期患者维生素 D 缺乏症的患病率为 40.7%，4 期为 61.5%，5 期为 85.7%。维生素 D 缺乏症亚组中糖尿病患者比例较高，eGFR 较低，蛋白尿较多。补充后，52 例（76.5%）患者在 3 个月时达到 25-羟维生素 D（25[OH]D）30ng/mL 或更高水平，61 例（89.7%）患者在 6 个月时维生素 D 恢复。基线时 25（OH）D 水平较低和蛋白尿较多是对维生素 D 补充反应较低的相关因素。
非透析性 CKD 患者维生素 D 缺乏率较高，随着肾功能下降，其比例增加。蛋白尿较多是补充剂无反应的独立危险因素。胆钙化醇补充可补充大多数患者的维生素 D，且无明显不良反应。
