Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Int Urol Nephrol. 2021 May;53(5):973-983. doi: 10.1007/s11255-020-02695-5. Epub 2021 Jan 9.
Evidence on vitamin D and parathyroid hormone (PTH) status in patients with early kidney impairment is limited. We aimed to determine the associations among kidney function, vitamin D, and PTH status in community-dwelling elderly patients with mild-to-moderate kidney impairment.
Community-dwelling elderly patients were enrolled in this Institutional Review Board approved cross-sectional study. The eligibility criteria were as follows: age > 60 years, no recent hospitalization within the past 12 months, no conditions that affect vitamin D status including vitamin D supplementation, and eGFR > 30 mL/min/1.73 m. Serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) levels were assessed.
A total of 226 patients were enrolled. Data were expressed as mean ± SD. The mean serum 25(OH)D was 26.61 ± 10.44 ng/mL and the mean serum PTH was 50.67 ± 22.67 pg/mL. The prevalence of vitamin D deficiency [25(OH)D < 20 ng/mL] and secondary hyperparathyroidism [PTH > 65 pg/mL] were 25.3% and 18.1%, respectively. Patients with eGFR 30- < 60 mL/min/1.73m had significantly higher prevalence of 25(OH)D < 20 ng/mL (33.7% versus 19.4%, p < 0.05) than patients with eGFR ≥ 60 mL/min/1.73 m. Multiple regression analysis showed independent negative association of serum PTH level with eGFR (mL/min/1.73 m, β: - 0.261, 95% CI [- 0.408, - 0.114]) and serum 25(OH)D (ng/mL, β: - 0.499, 95% CI [- 0.775, - 0.223], adjusted for possible confounders).
The prevalence of vitamin D deficiency was higher in patients with eGFR 30 - < 60 mL/min/1.73 m than those with eGFR ≥ 60 mL/min/1.73 m. Both decreased serum 25(OH)D levels and decreased eGFR were independently associated with increased serum PTH levels among these patients.
关于早期肾功能损害患者的维生素 D 和甲状旁腺激素（PTH）状态的证据有限。我们旨在确定社区居住的轻度至中度肾功能损害老年患者中肾功能、维生素 D 和 PTH 状态之间的关联。
本研究为机构审查委员会批准的横断面研究，纳入了社区居住的老年患者。入选标准如下：年龄＞60 岁，过去 12 个月内无近期住院，无影响维生素 D 状态的条件，包括维生素 D 补充，和 eGFR＞30mL/min/1.73m。评估血清 25-羟维生素 D [25(OH)D] 和甲状旁腺激素 (PTH) 水平。
共纳入 226 例患者。数据表示为均值±标准差。血清 25(OH)D 的平均值为 26.61±10.44ng/mL，血清 PTH 的平均值为 50.67±22.67pg/mL。维生素 D 缺乏症[25(OH)D＜20ng/mL]和继发性甲状旁腺功能亢进症[PTH＞65pg/mL]的患病率分别为 25.3%和 18.1%。eGFR 为 30-＜60mL/min/1.73m 的患者，25(OH)D＜20ng/mL 的患病率明显高于 eGFR≥60mL/min/1.73m 的患者（33.7%比 19.4%，p＜0.05）。多元回归分析显示，血清 PTH 水平与 eGFR（mL/min/1.73m，β：-0.261，95%CI[-0.408，-0.114]）和血清 25(OH)D（ng/mL，β：-0.499，95%CI[-0.775，-0.223]）呈独立负相关，校正了可能的混杂因素。
eGFR 为 30-＜60mL/min/1.73m 的患者中维生素 D 缺乏症的患病率高于 eGFR≥60mL/min/1.73m 的患者。这些患者中，血清 25(OH)D 水平降低和 eGFR 降低均与血清 PTH 水平升高独立相关。
