Kondo Masumi, Toyoda Masao, Miyatake Han, Tanaka Eitaro, Koizumi Masahiro, Komaba Hirotaka, Kimura Moritsugu, Umezono Tomoya, Fukagawa Masafumi
Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Japan.
Intern Med. 2016;55(18):2555-62. doi: 10.2169/internalmedicine.55.6346. Epub 2016 Sep 15.
Objective The purpose of this study was to measure serum 25-hydroxyvitamin D [25(OH)D] levels in Japanese patients with diabetic nephropathy and determine the relationship between 25(OH)D concentrations and various factors. Methods The study subjects included 442 patients with type 2 diabetes. Their serum levels of creatinine, HbA1c, intact-parathyroid hormone, urinary albumin, 25(OH)D, and 1,25-dihydroxyvitamin D [1,25(OH)2D] were measured and their estimated glomerular filtration rate (eGFR) was determined. The patients were divided into four groups based on the risk for progression to chronic kidney disease (CKD): low, moderate, high, very high, based on their eGFR and their level of albuminuria. Results The median 25(OH)D level was 14.6 ng/mL; 11% of the patients had 25(OH)D deficiency (<10 ng/mL), and 2% of patients had active vitamin D deficiency, as defined by a 1,25(OH)2D level of <22 pg/mL. The serum 25(OH)D level was correlated with the serum 1,25(OH)2D level in patients with a very high risk for CKD, but not in those with a moderate or high risk for CKD. Conclusion Although the vitamin D levels of the Japanese patients with diabetic nephropathy and CKD were low, the prevalence of vitamin D deficiency, as defined by the 1,25(OH)2D level, was low. Albuminuria, younger age, and female gender were associated with a low 25(OH)D level. The serum level of 25(OH)D should be monitored to assess the vitamin D status of patients with nephropathy and CKD.
目的 本研究旨在测定日本糖尿病肾病患者的血清25-羟基维生素D[25(OH)D]水平，并确定25(OH)D浓度与各种因素之间的关系。方法 研究对象包括442例2型糖尿病患者。测定他们的血清肌酐、糖化血红蛋白、全段甲状旁腺激素、尿白蛋白、25(OH)D和1,25-二羟基维生素D[1,25(OH)₂D]水平，并确定他们的估算肾小球滤过率(eGFR)。根据慢性肾脏病(CKD)进展风险，将患者分为四组：低、中、高、极高，分组依据为eGFR和蛋白尿水平。结果 25(OH)D水平中位数为14.6 ng/mL；11%的患者存在25(OH)D缺乏(<10 ng/mL)，2%的患者存在活性维生素D缺乏，定义为1,25(OH)₂D水平<22 pg/mL。血清25(OH)D水平与CKD极高风险患者的血清1,25(OH)₂D水平相关，但与CKD中度或高风险患者无关。结论 尽管日本糖尿病肾病和CKD患者的维生素D水平较低，但根据1,25(OH)₂D水平定义的维生素D缺乏患病率较低。蛋白尿、年轻和女性性别与低25(OH)D水平相关。应监测血清25(OH)D水平以评估肾病和CKD患者的维生素D状态。
