《美国黑人血液 25-羟维生素 D 与慢性肾脏病结局的影响因素：杰克逊心脏研究》
Modifiers of Plasma 25-Hydroxyvitamin D and Chronic Kidney Disease Outcomes in Black Americans: The Jackson Heart Study.
机构信息
Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
出版信息
J Clin Endocrinol Metab. 2019 Jun 1;104(6):2267-2276. doi: 10.1210/jc.2018-01747.
BACKGROUND
25-hydroxyvitamin D [25(OH)D] is lower in black compared with white Americans but is not consistently associated with outcomes in this group, possibly due to genetic and other biological differences. We examined the association of plasma 25(OH)D and renal outcomes in black Americans with a focus on effect modifiers.
METHODS
We studied associations between baseline 25(OH)D with (i) annual rate of estimated glomerular filtration rate (eGFR) decline and (ii) incident chronic kidney disease (CKD) in the Jackson Heart Study, a prospective cohort of black Americans. Plasma 25(OH)D levels were corrected for monthly variation in sunlight exposure using the residual method. We used adjusted generalized linear models to evaluate outcomes and assessed potential effect modification by diabetes mellitus, vitamin D binding protein (DBP) genotype, obesity, dietary sodium intake, and use of renin-angiotensin-aldosterone system inhibitors.
RESULTS
Among 5164 participants with 25(OH)D available, plasma 25(OH)D was 14.5 ± 6.5 ng/mL (mean ± SD), and eGFR was 94.1 ± 22.0 mL/min/1.73 m2. Over a median of 8 years, eGFR decline was 1.3 ± 2.0 mL/min/1.73 m2 per year in 3228 participants with complete data, and 220 out of 1803 eligible participants developed incident CKD. Overall, 25(OH)D was not associated with eGFR decline in fully adjusted models. However, higher 25(OH)D was associated with slower eGFR decline among those with diabetes: each 5 ng/mL higher 25(OH)D was associated with a 0.27 mL/min/1.73 m2/y slower eGFR decline (95% CI, 0.13 to 0.41; P < 0.001). Higher 25(OH)D was not associated with incident CKD overall, but it was associated with lower odds of incident CKD among participants with the GG or GT genotype at rs7041 in the gene encoding DBP [OR, 0.69 per 5 ng/mL higher 25(OH)D; 95% CI, 0.51 to 0.93; P-interaction = 0.005]. Other interactions were not significant.
CONCLUSION
These findings support a potential benefit of higher 25(OH)D for kidney health in black Americans with diabetes or specific variants in DBP.
背景
与白种美国人相比，黑种美国人的 25-羟维生素 D [25(OH)D]水平较低，但 25(OH)D 与该人群的结局并不始终相关，这可能是由于遗传和其他生物学差异所致。我们研究了黑人美国人的血浆 25(OH)D 与（i）估算肾小球滤过率（eGFR）下降的年速率和（ii）慢性肾脏病（CKD）事件之间的关联，并重点研究了效应修饰物。
方法
我们使用黑人美国人前瞻性队列研究——杰克逊心脏研究（Jackson Heart Study）中的基线 25(OH)D 与（i）每年估算肾小球滤过率（eGFR）下降速度和（ii）新发慢性肾病（CKD）的关系。使用残差法校正了每月阳光暴露对血浆 25(OH)D 水平的影响。我们使用调整后的广义线性模型来评估结局，并评估了糖尿病、维生素 D 结合蛋白（DBP）基因型、肥胖、膳食钠摄入量和肾素-血管紧张素-醛固酮系统抑制剂使用情况等因素的潜在效应修饰作用。
结果
在 5164 名可提供 25(OH)D 数据的参与者中，血浆 25(OH)D 为 14.5±6.5ng/mL（均值±标准差），eGFR 为 94.1±22.0mL/min/1.73m2。在中位随访 8 年期间，3228 名完成数据记录的参与者中，eGFR 下降速度为每年 1.3±2.0mL/min/1.73m2，1803 名符合条件的参与者中有 220 名发生了 CKD 事件。总体而言，在完全调整的模型中，25(OH)D 与 eGFR 下降无关。然而，较高的 25(OH)D 与糖尿病患者中 eGFR 下降速度较慢有关：25(OH)D 每升高 5ng/mL，eGFR 下降速度就会降低 0.27mL/min/1.73m2/y（95%CI，0.13 至 0.41；P<0.001）。较高的 25(OH)D 与总体 CKD 发生率无关，但与 DBP 基因编码区 rs7041 位点 GG 或 GT 基因型参与者的 CKD 事件发生率较低相关[比值比，每升高 5ng/mL 25(OH)D 事件发生风险降低 0.69；95%CI，0.51 至 0.93；P 交互值=0.005]。其他交互作用无统计学意义。
结论
这些发现支持了黑人美国人中较高的 25(OH)D 水平对糖尿病患者或 DBP 特定变异患者的肾脏健康可能有益。
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