长期补充胆钙化醇对维生素 D 缺乏的慢性肾脏病患者血管钙化的影响。
The Effect of Long-Term Cholecalciferol Supplementation on Vascular Calcification in Chronic Kidney Disease Patients With Hypovitaminosis D.
机构信息
Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.
Cardios Research Institute, São Paulo, Brazil.
出版信息
J Ren Nutr. 2019 Sep;29(5):407-415. doi: 10.1053/j.jrn.2018.12.002. Epub 2019 Jan 25.
OBJECTIVE
The role of vitamin D supplementation on vascular calcification (VC) in patients with chronic kidney disease (CKD) is controversial. The objective of this study was to evaluate the effects of long-term cholecalciferol supplementation on VC in nondialysis patients with CKD stages 3-4 with hypovitaminosis D.
DESIGN AND METHODS
Eighty patients aged 18-85 years with creatinine clearance between 15 and 60 mL/min/1.73 m and serum 25(OH)D level < 30 ng/mL were enrolled in a 18-month prospective study. Individuals with vitamin D insufficiency (25-hydroxyvitamin D [25(OH)D] level between 16 and 29 ng/mL) were included in a randomized, double-blind, two-arm study to receive cholecalciferol or placebo. Patients with vitamin D deficiency [25(OH)D < 15 ng/mL] were included in an observational study and mandatorily received cholecalciferol. The coronary artery calcium score was obtained by multislice computed tomography at baseline and the 18th month.
RESULTS
During the study, VC did not change in the treated insufficient group (418 [81-611] to 364 [232-817] AU, P = 0.25) but increased in the placebo group (118 [37-421] to 199 [49-490] AU, P = 0.01). The calcium score change was inversely correlated with 25(OH)D change (r = -0.45; P = 0.037) in the treated insufficient group but not in the placebo group. Renal function did not change in the insufficient, treated, and placebo groups. In multivariate analysis, there was no difference in VC progression between the treated and placebo insufficient groups (interaction P = 0.92). In the deficient group, VC progressed (265 [84-733] to 333 [157-745] AU; P = 0.006) and renal function declined (33 [26-43] to 23 [17-49] mL/min/1.73 m; P = 0.04). The calcium score change was inversely correlated with cholecalciferol cumulative doses (r = -0.41; P = 0.048) and kidney function change (r = -0.43; P = 0.033) but not with 25(OH)D change (r = -0.08; P = 0.69).
CONCLUSION
Vitamin D supplementation did not attenuate VC progression in CKD patients with hypovitaminosis D.
CONCLUSION
Vitamin D supplementation did not attenuate VC progression in CKD patients with hypovitaminosis D.
目的
维生素 D 补充剂对慢性肾脏病（CKD）患者血管钙化（VC）的作用存在争议。本研究旨在评估长期胆钙化醇补充对维生素 D 缺乏的 CKD 3-4 期非透析患者 VC 的影响。
设计和方法
80 名年龄在 18-85 岁之间、肌酐清除率在 15 至 60 ml/min/1.73 m 之间且血清 25（OH）D 水平<30ng/ml 的患者参加了一项为期 18 个月的前瞻性研究。将维生素 D 不足（25-羟维生素 D [25（OH）D]水平在 16 至 29ng/ml 之间）的患者纳入随机、双盲、双臂研究，以接受胆钙化醇或安慰剂治疗。维生素 D 缺乏[25（OH）D <15ng/ml]的患者纳入观察性研究，并强制性给予胆钙化醇治疗。在基线和第 18 个月时，通过多层计算机断层扫描获得冠状动脉钙评分。
结果
在研究期间，治疗不足组的 VC 没有变化（418[81-611]至 364[232-817]AU，P=0.25），但安慰剂组的 VC 增加（118[37-421]至 199[49-490]AU，P=0.01）。治疗不足组中，钙评分变化与 25（OH）D 变化呈负相关（r=-0.45；P=0.037），但安慰剂组中无相关性。不足、治疗和安慰剂组的肾功能均未改变。多变量分析显示，治疗不足组和安慰剂组的 VC 进展无差异（交互 P=0.92）。在缺乏组中，VC 进展（265[84-733]至 333[157-745]AU；P=0.006），肾功能下降（33[26-43]至 23[17-49]ml/min/1.73 m；P=0.04）。钙评分变化与胆钙化醇累积剂量（r=-0.41；P=0.048）和肾功能变化（r=-0.43；P=0.033）呈负相关，但与 25（OH）D 变化（r=-0.08；P=0.69）无相关性。
结论
维生素 D 补充剂不能减缓维生素 D 缺乏的 CKD 患者的 VC 进展。
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