Krummel Thierry, Ingwiller Maxime, Keller Nicolas, Prinz Eric, Charlin Emmanuelle, Bazin Dorothée, Hannedouche Thierry
Department of Nephrology, Hôpitaux Universitaires de Strasbourg 1, Place de L'Hôpital, 67000, Strasbourg, France.
School of Medicine, University of Strasbourg, Strasbourg, France.
Int Urol Nephrol. 2022 Apr;54(4):895-905. doi: 10.1007/s11255-021-02950-3. Epub 2021 Jul 20.
Residual albuminuria is associated with an increased risk of progression to ESKD. We tested whether a supplementation with native vitamin D could reduce albuminuria in stable CKD patients under maximal renin-angiotensin system (RAS) blockade.
We conducted a randomized controlled study of high (cholecalciferol 100 000 UI per 10 days over 1 month) vs low-dose (ergocalciferol 400 UI/days over 1 month) supplementation with native vitamin D on urinary albumin/creatinine ratio, blood pressure and the RAS over 1 month in stable CKD patients with albuminuria and maximum tolerated RAS blockade.
We included 31 patients, 21 in the high dose group and 10 in the low dose group. In contrast with a low dose, high dose vitamin D normalized plasma 25(OH)D, decreased iPTH but slightly increased plasma phosphate. High dose vitamin D decreased geometric mean UACR from 99.8 mg/mmol (CI 95% 60.4-165.1) to 84.7 mg/mmol (CI 95% 51.7-138.8, p = 0.046). In the low dose group, the change in geometric mean UACR was not significant. Blood pressure, urinary 24 h aldosterone and peaks and AUC of active renin concentrations after acute stimulation by a single dose of 100 mg captopril were unaffected by the supplementation in native vitamin D, irrespective of the dose. Native vitamin D supplementation was well tolerated.
We found a small (- 15%) but significant decrease in albuminuria after high dose vitamin D supplementation. We found no effect of vitamin D repletion on blood pressure and the systemic RAS, concordant with recent clinical studies.
残余蛋白尿与进展至终末期肾病（ESKD）的风险增加相关。我们测试了补充天然维生素D是否能降低在最大肾素 - 血管紧张素系统（RAS）阻断治疗下的稳定慢性肾脏病（CKD）患者的蛋白尿。
我们进行了一项随机对照研究，对有蛋白尿且RAS阻断达到最大耐受剂量的稳定CKD患者，给予高剂量（胆钙化醇100000单位，每10天一次，共1个月）与低剂量（麦角钙化醇400单位/天，共1个月）天然维生素D补充剂，观察1个月内尿白蛋白/肌酐比值、血压和RAS的变化。
我们纳入了31例患者，高剂量组21例，低剂量组10例。与低剂量组相比，高剂量维生素D使血浆25(OH)D水平正常化，降低了iPTH，但使血浆磷酸盐略有升高。高剂量维生素D使几何平均尿白蛋白/肌酐比值从99.8mg/mmol（95%CI 60.4 - 165.1）降至84.7mg/mmol（95%CI 51.7 - 此时文本似乎不完整，应是138.8，p = 0.046）。在低剂量组，几何平均尿白蛋白/肌酐比值的变化不显著。无论剂量如何，血压、尿24小时醛固酮以及单剂量100mg卡托普利急性刺激后活性肾素浓度的峰值和曲线下面积均不受天然维生素D补充剂的影响。天然维生素D补充剂耐受性良好。
我们发现高剂量补充维生素D后蛋白尿有小幅（-15%）但显著的降低。我们发现维生素D补充对血压和全身RAS无影响，这与近期临床研究一致。
