Vitamin D and UV exposure in chronic kidney disease.
Vitamin D and UV exposure in chronic kidney disease.
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DOI：
10.4161/derm.24539
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发表时间：
2013-01-01
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影响因子：
--
通讯作者：
Krause R
中科院分区：
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作者：
Krause R
随着肾功能的丧失和肾小球滤过率的降低，血清25-羟维生素D [25（OH）D]和1，25-二羟维生素D [1，25（OH）2 D]常常同时降低。在德国肾脏替代治疗（血液透析，腹膜透析，肾移植）患者的代表性群体中，我们的小组回顾性分析了12年（1995年至2006年）的维生素D状态。血清25（OH）D> 30 ng/ml者仅占11%，<20 ng/ml者占70%以上。在临床试验中，我们使用模拟阳光的人造灯在皮肤中产生维生素D3。在常规血液透析治疗期间使用部分身体照射（15%体表）。在血液透析治疗前，每周三次以站立姿势进行全身UV暴露。在这两种方法中，我们观察到血清25（OH）2D3水平增加约10%。35 - 50%，持续2 - 3个月，维持骨小梁矿物质密度，收缩压和舒张压正常化。在全身辐射干预期间，心率变异性改善了20 - 25%。在开始常规血液透析治疗前定期持续全身照射两到三次的患者，循环25（OH）D3和1，25（OH）2D3保持正常水平。因此，根据我们的数据，可以建议间歇性皮下UVB暴露与太阳模拟光谱是有效的治疗和/或预防维生素D缺乏症的慢性和终末期肾病患者。
With loss of renal function and decreasing glomerula filtration rate the serum levels of 25-hydroxyvitamin D [25(OH)D] as well as 1,25-dihydroxyvitamin D [1,25 (OH)2 D] often decrease simultaneously. In representative groups of German patients on renal replacement therapy (hemodialysis, peritoneal dialysis, kidney transplantation) our group retrospectively analyzed the vitamin D status over a period of 12 y (1995‒2006). Only 11% of patients had a serum level of 25(OH)D that was > 30 ng/ml, more than 70% had a level of 25(OH)D < 20 ng/ml. In clinical trials we used sun-simulating artificial lamps to produce vitamin D3 in the skin. Partial-body irradiation (15% of body surface) was used during the routine hemodialysis treatment. Whole-body UV exposure was done in a standing position three times a week before the hemodialysis treatment. With both procedures we observed an increase of the serum level of 25(OH)2D3 by approx. 35–50% over a period of 2‒3 mo, maintenance of trabecular bone mineral density and a normalization of systolic and diastolic blood pressure. Heart rate variability improved during the whole-body radiation intervention period by 20‒25%. Patients who continued the whole-body irradiation regularly two or three times before starting the routine hemodialysis session had maintained normal levels of circulating 25(OH)D3 and of 1,25(OH)2D3. Therefore, from our data it can be recommended that intermittent suberythemal UVB exposure with a sun-simulation spectrum is effective to treat and/or protect against vitamin D deficiency in chronic and end-stage kidney disease patients.