Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510515, China.
Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China.
J Endocrinol Invest. 2024 Nov;47(11):2745-2755. doi: 10.1007/s40618-024-02383-6. Epub 2024 May 11.
While serum 25-hydroxyvitamin D (25[OH]D) deficiency is prevalent in chronic kidney disease (CKD), the effects of 25(OH)D deficiency on cardiovascular mortality and kidney outcomes in patients with early-stage CKD remain incompletely understood.
This multicenter retrospective cohort study included adult patients with stages 1-3 CKD from 19 medical centers across China between January 2000 and May 2021. The primary outcome was cardiovascular mortality. The secondary study outcome included CKD progression (defined as a sustained > 40% eGFR decrease from baseline or progress to end-stage kidney disease), and annual percentage change of eGFR.
Of 9229 adults with stages 1-3 CKD, 27.0% and 38.9% had severe (< 10 ng/mL) and moderate (10 to < 20 ng/mL) serum 25(OH)D deficiency, respectively. Compared with patients having 25(OH)D ≥ 20 ng/mL, a significantly higher risk of cardiovascular mortality (hazard ratio [HR] 1.90, 95% CI 1.37-2.63), CKD progression (HR 2.20, 95% CI 1.68-2.88), and a steeper annual decline in eGFR (estimate - 7.87%; 95% CI - 10.24% to - 5.51% per year) was found in those with serum 25(OH)D < 10 ng/mL. Similar results were obtained in subgroups and by sensitivity analyses.
25(OH)D deficiency is associated with increased risks of cardiovascular mortality and CKD progression in patients with early-stage CKD. Studies are needed to determine whether early intervention for 25(OH)D deficiency could improve the prognosis of patients with early-stage CKD.
虽然慢性肾脏病（CKD）患者中血清 25-羟维生素 D（25[OH]D）缺乏很常见，但 25（OH）D 缺乏对早期 CKD 患者心血管死亡率和肾脏结局的影响仍不完全清楚。
这项多中心回顾性队列研究纳入了 2000 年 1 月至 2021 年 5 月期间来自中国 19 家医疗中心的 1-3 期 CKD 成年患者。主要结局为心血管死亡率。次要研究结局包括 CKD 进展（定义为从基线开始 eGFR 持续下降>40%或进展至终末期肾病）和 eGFR 年变化率。
在 9229 名 1-3 期 CKD 成人患者中，分别有 27.0%和 38.9%的患者存在严重（<10ng/mL）和中度（10-<20ng/mL）血清 25（OH）D 缺乏。与血清 25（OH）D≥20ng/mL 的患者相比，血清 25（OH）D<10ng/mL 的患者心血管死亡率（风险比 [HR]1.90，95%置信区间 [CI]1.37-2.63）、CKD 进展（HR 2.20，95%CI1.68-2.88）和 eGFR 年下降率（估计值-7.87%；95%CI-10.24%至-5.51%/年）均显著升高。在亚组和敏感性分析中也得到了类似的结果。
25（OH）D 缺乏与早期 CKD 患者的心血管死亡率和 CKD 进展风险增加相关。需要研究早期干预 25（OH）D 缺乏是否可以改善早期 CKD 患者的预后。
