Dysregulated mineral metabolism in patients with acute kidney injury and risk of adverse outcomes.
Dysregulated mineral metabolism in patients with acute kidney injury and risk of adverse outcomes.
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DOI：
10.1111/cen.12172
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发表时间：
2013-10
影响因子：
3.2
通讯作者：
Stern L
中科院分区：
文献类型：
--
作者：
Leaf DE;Waikar SS;Wolf M;Cremers S;Bhan I;Stern L
许多研究评估了维生素D缺乏在慢性肾脏疾病和终末期肾脏疾病患者中的患病率和重要性，但对急性肾损伤(AKI)患者的维生素D水平知之甚少。我们评估了AKI患者维生素D代谢产物与临床结果之间的关系。前瞻性队列研究。30名AKI参与者和30名来自普通医院病房和三级护理医院重症监护病房的对照组。分别于AKI发病后24小时内和5天后测定血浆25-羟基维生素D[25(OH)D]、1，25-二羟基维生素D[1，25(OH)2D]、24R，25-二羟基维生素D3、维生素D结合蛋白(VDBP)和成纤维细胞生长因子23(FGF23)水平。生物可利用的25(OH)D和1，25(OH)2D水平被定义为自由和白蛋白结合的25(OH)D和1，25(OH)2D的总和。与对照组相比，AKI的参与者在登记时1，25(OH)2D水平[17(10-22)pg/ml比25(15-35)pg/ml，p=0.003]，VDBP水平[23(15-31)比29(25-36)mg/dl，p=0.003]，以及相似的生物可利用25(OH)D和1，25(OH)2D水平。在整个样本中，生物可利用的25(OH)D水平与脓毒症的严重程度呈负相关(p<；0.001)。在AKI参与者中，在调整了年龄和血肌酐后，生物可利用25(OH)D，而不是其他维生素D代谢物，与死亡率显著相关(调整后的优势比每1SD ln[生物可利用25(OH)D]=0.16，95%可信区间=0.03至0.85)。生物可利用的25(OH)D可作为AKI患者不良结局的生物标志物或中介物。
Numerous studies have evaluated the prevalence and importance of vitamin D deficiency among patients with chronic kidney disease and end-stage renal disease, however, little is known about vitamin D levels in acute kidney injury (AKI). We evaluated the association between vitamin D metabolites and clinical outcomes among patients with AKI. Prospective cohort study. 30 participants with AKI and 30 controls from general hospital wards and intensive care units at a tertiary care hospital. Plasma levels of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D], 24R,25-dihydroxyvitamin D3, vitamin D binding protein (VDBP), and fibroblast growth factor 23 (FGF23) were measured within 24 hours of AKI onset and 5 days later. Bioavailable 25(OH)D and 1,25(OH)2D levels, defined as the sum of free- and albumin-bound 25(OH)D and 1,25(OH)2D, were estimated using equations. Compared to controls, participants with AKI had lower levels of 1,25(OH)2D [17 (10-22) versus 25 (15-35) pg/ml, p=0.01], lower levels of VDBP [23 (15-31) versus 29 (25-36) mg/dl, p=0.003], and similar levels of bioavailable 25(OH)D and 1,25(OH)2D at enrollment. Levels of bioavailable 25(OH)D were inversely associated with severity of sepsis in the overall sample (p<0.001). Among participants with AKI, bioavailable 25(OH)D, but not other vitamin D metabolites, was significantly associated with mortality after adjusting for age and serum creatinine (adjusted odds ratio per 1 SD ln [bioavailable 25(OH)D]=0.16, 95% confidence interval=0.03 to 0.85). Bioavailable 25(OH)D could have a role as a biomarker or mediator of adverse outcomes among patients with established AKI.
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在重症监护开始时，低血清25-羟基维生素D与死亡率增加有关。
影响因子：
8.8
作者：
Braun AB;Gibbons FK;Litonjua AA;Giovannucci E;Christopher KB
通讯作者：
Christopher KB
影响因子：
3
作者：
Matthews, L. Ray;Ahmed, Yusuf;Wilson, Kenneth L.;Griggs, Diane D.;Danner, Omar K.
通讯作者：
Danner, Omar K.
影响因子：
19.6
作者：
HSU, CH;PATEL, S;SIMPSON, RU
通讯作者：
SIMPSON, RU
影响因子：
8.8
作者：
Levy, MM;Fink, MP;Ramsay, G
通讯作者：
Ramsay, G
影响因子：
56.9
作者：
Liu, PT;Stenger, S;Modlin, RL
通讯作者：
Modlin, RL