25-hydroxyvitamin D levels and albuminuria in the Third National Health and Nutrition Examination Survey (NHANES III)
25-hydroxyvitamin D levels and albuminuria in the Third National Health and Nutrition Examination Survey (NHANES III)
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DOI：
10.1053/j.ajkd.2007.04.015
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发表时间：
2007-07-01
影响因子：
13.2
通讯作者：
Weiss, Noel S.
中科院分区：
文献类型：
--
作者：
de Boer, Ian H.;Ioannou, George N.;Weiss, Noel S.
背景：蛋白尿是慢性肾脏疾病进展、终末期肾脏疾病、心血管事件和死亡率的危险因素。动物研究表明，维生素D不足可能与蛋白尿的发病机制有关。研究设计：横断面研究。环境与参与者：15068名成年人参加了第三次全国健康与营养调查。预测指标：血清25-羟基维生素D浓度，以四分位数检测。结果和测量：蛋白尿，使用既定的性别特异性尿白蛋白-肌酐比值的临界值来定义（女性为25 - 2999 mg/g，男性为17 - 2999 mg/g）。结果：随着维生素D浓度四分位数的降低，蛋白尿患病率逐步增加：8.9%,11.5%，13.7%和15.8% （P < 0.001）。调整年龄、性别、种族/民族、地区和测量季节、吸烟状况、体重指数和估计的肾小球滤过率后，维生素D浓度降低四分位数导致蛋白尿的相对风险分别为1.00（参照组）、1.14（95%可信区间，0.95 ~ 1.37）、1.22（95%可信区间，1.03 ~ 1.45）和1.37（95%可信区间，1.10 ~ 1.71;P = 0.006）。此外，调整血压和糖尿病，这些风险有所减弱，并保持统计学意义。局限性：本研究的横断面设计不允许证明维生素D和蛋白尿之间的时间或因果关系。结论：需要进一步的研究来阐明维生素D与蛋白尿的关系，并确定维生素D治疗是否可以预防或改善肾脏和心血管疾病的标志物。
Background: Albuminuria is a risk factor for chronic kidney disease progression, end-stage renal disease, cardiovascular events, and mortality. Animal studies suggested that vitamin D insufficiency may contribute to the pathogenesis of albuminuria.Study Design: Cross-sectional study.Setting & Participants: 15,068 adults participating in the Third National Health and Nutrition Examination Survey.Predictor: Serum 25-hydroxyvitamin D concentration, examined in quartiles.Outcomes & Measurements: Albuminuria, defined using established sex-specific cutoff values for urine albumin-creatinine ratio (25 to 2,999 mg/g for women, 17 to 2,999 mg/g for men).Results: A stepwise increase in the prevalence of albuminuria was observed with decreasing quartiles of vitamin D concentration: 8.9%, 11.5%, 13.7%, and 15.8% (P < 0.001). Adjusting for age, sex, race/ethnicity, region and season of measurement, smoking status, body mass index, and estimated glomerular filtration rate, relative risks for albuminuria by decreasing quartile of vitamin D concentration were 1.00 (reference group), 1.14 (95% confidence interval, 0.95 to 1.37), 1.22 (95% confidence interval, 1.03 to 1.45), and 1.37 (95% confidence interval, 1.10 to 1.71; P = 0.006). Additionally adjusting for blood pressure and diabetes mellitus, these risks were somewhat attenuated and retained statistical significance.Limitations: The cross-sectional design of this study does not allow demonstration of temporal or causal relationships between vitamin D and albuminuria.Conclusions: Additional studies are needed to clarify the relationship of vitamin D with albuminuria and determine whether vitamin D therapy prevents or improves markers of kidney and cardiovascular disease.