[维生素D及其对肾移植受者甲状旁腺激素/维生素D/钙-成纤维细胞生长因子23/α-klotho/磷轴的积极作用]

[Vitamin D and its positive effect on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in kidney transplant recipients].

作者信息

Balcázar-Hernández Lourdes, Manuel-Apolinar Leticia, Vargas Ortega Guadalupe, González-Virla Baldomero, Reza-Albarrán Alfredo Adolfo, Jiménez Martínez María Del Carmen, Martínez Ordaz José Luis, Mendoza-Zubieta Victoria, Basurto Lourdes

机构信息

Programa de Maestría y Doctorado en Ciencias Médicas y Odontológicas. Universidad Nacional Autónoma de México. Departamento de Endocrinología. Hospital de Especialidades. Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social.

Departamento de Endocrinología. Hospital de Especialidades. Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social.

出版信息

Nutr Hosp. 2023 Apr 20;40(2):428-435. doi: 10.20960/nh.04415.

DOI:10.20960/nh.04415

PMID:36926938

Abstract

Background: hypovitaminosis D is frequent in kidney transplant recipient (KTR) patients and is associated with deleterious effects both at the bone and extraosseous levels. Treatment with cholecalciferol is effective for the normalization of 25(OH)D, demonstrating a beneficial effect on the calcium-tropic axis in other populations; however, its effect on the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis in RTR has not been reported. The aim of this study was to evaluate the effect of normalization of serum 25(OH)D concentrations on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in KTR treated with cholecalciferol, as well as the association between the components of this axis. Methods: a prospective study in 23 KTR with hypovitaminosis D, with evolution from 1 to 12 months post-transplantation, an estimated glomerular filtration rate > 60 mL/min/1.73 m2 and a history of primary nephropathy treated with cholecalciferol, in whom the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis was evaluated during the state of hypovitaminosis D and at normalization of 25(OH)D. Results: at the normalization of 25(OH)D, a reduction in PTH [103 (58.5-123.9) vs 45.6 (30.1-65.1) pg/mL; p = 0.002] and an increase in serum phosphorus [3.1 (2.3-3.5) vs 3.3 (3-3.6) mg/dL; p = 0.01] were evident, with no differences in calcium, klotho and FGF23 concentrations. The time to achieve normalization of 25(OH)D was 12 weeks (RIC, 4-12), with a dose of 5000 IU/day (RIC, 4000-6000). A positive association between klotho and PTH was corroborated (r = 0.54; p = 0.008; linear regression, β = 0.421; B = 0.004; 95 % CI, 0.003-0.007; p = 0.045). Conclusions: treatment with cholecalciferol is effective for the normalization of 25(OH)D, with a beneficial effect on calcium-phosphotropic metabolism characterized by a reduction in PTH concentration, without significant changes in calcemia or calciuria, as well as an increase in phosphatemia, without modifications in FGF23 or klotho concentrations.

摘要

背景

维生素D缺乏在肾移植受者（KTR）中很常见，并且在骨骼和骨外水平均具有有害影响。胆钙化醇治疗可有效使25（OH）D正常化，在其他人群中显示出对钙调节轴的有益作用；然而，其对肾移植受者（RTR）的甲状旁腺激素/维生素D/钙和成纤维细胞生长因子23/α-klotho/磷轴的影响尚未见报道。本研究的目的是评估用胆钙化醇治疗的KTR中血清25（OH）D浓度正常化对甲状旁腺激素/维生素D/钙-成纤维细胞生长因子23/α-klotho/磷轴的影响，以及该轴各成分之间的关联。方法：对23例维生素D缺乏的KTR进行前瞻性研究，这些患者在移植后1至12个月，估计肾小球滤过率>60 mL/min/1.73 m2，并有原发性肾病且接受胆钙化醇治疗的病史，在维生素D缺乏状态和25（OH）D正常化时评估其甲状旁腺激素/维生素D/钙和成纤维细胞生长因子23/α-klotho/磷轴。结果：在25（OH）D正常化时，甲状旁腺激素降低[103（58.5 - 123.9）对45.6（30.1 - 65.1）pg/mL；p = 0.002]，血清磷升高[3.1（2.3 - 3.5）对3.3（3 - 3.6）mg/dL；p = 0.01]，血钙、α-klotho和成纤维细胞生长因子23浓度无差异。实现25（OH）D正常化的时间为12周（四分位间距，4 - 12），剂量为5000 IU/天（四分位间距，4000 - 6000）。证实α-klotho与甲状旁腺激素之间存在正相关（r = 0.54；p = 0.008；线性回归，β = 0.421；B = 0.004；95%置信区间，0.003 - 0.007；p = 0.045）。结论：胆钙化醇治疗可有效使25（OH）D正常化，对钙磷代谢有有益作用，其特征为甲状旁腺激素浓度降低，血钙或尿钙无显著变化，血磷升高，成纤维细胞生长因子23或α-klotho浓度无改变。