Hypovitaminosis D in chronic kidney disease
Hypovitaminosis D in chronic kidney disease
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DOI：
10.2215/cjn.05781207
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发表时间：
2008-07-01
影响因子：
9.8
通讯作者：
Norris, Keith
中科院分区：
文献类型：
--
作者：
Mehrotra, Rajnish;Kermah, Dulcie;Norris, Keith
背景和目的：最近的研究表明，慢性肾脏疾病患者中25-羟基维生素D水平偏低的发生率很高。这项研究试图验证这一假设，即25-羟基维生素D缺乏的患病率在慢性肾脏疾病患者中显著高于糖尿病肾病患者，在糖尿病肾病患者中，血清25-羟基维生素D水平低与血清甲状旁腺激素异常、骨密度和冠状动脉钙化相关。设计、背景、参与者和测量：研究A使用来自第三次国家健康和营养检查调查的数据。研究B是对一项非透析依赖型糖尿病肾病冠状动脉钙化的观察性研究的事后分析。结果：在研究A中，慢性肾脏病患者25-羟基维生素D缺乏的调整优势增加32%。然而，25-羟基维生素D缺乏症的高患病率不能用维生素D总摄入量的差异来解释。对146例糖尿病肾病患者的25-羟基维生素D水平低于最佳水平的后果进行了分析。经多因素调整后，血清25-羟基维生素D和甲状旁腺激素水平之间的显著负相关关系减弱到不显著水平。骨密度与冠状动脉钙化积分之间存在显著的负相关；两者均与血清25-羟基维生素D水平无关。在研究的72名患者中，在12.4+/-0.4个月后，血清25-羟基维生素D水平略有下降。结论：25-羟基维生素D缺乏症在慢性肾脏疾病中更常见，但这种较高的患病率不太可能是维生素D摄入量较低所致。25-羟基维生素D水平低于最佳水平的后果仍有待明确阐明。
Background and objectives: Recent studies show high prevalence of suboptimal 25-hydroxyvitamin D levels in chronic kidney disease patients. This study sought to test the hypothesis that the prevalence of 25-hydroxyvitamin D deficiency is significantly higher in chronic kidney disease patients and, in diabetic nephropathy, low serum 25-hydroxyvitamin D is associated with abnormal serum parathyroid hormone, bone mineral density, and coronary artery calcification.Design, setting, participants, & measurements: Study A used data from the Third National Health and Nutrition Examination Survey. Study B was a post hoc analysis of an observational study of coronary artery calcification in non-dialysis-dependent diabetic nephropathy.Results: In study A, the adjusted odds for 25-hydroxyvitamin D deficiency were 32% higher in chronic kidney disease patients. This higher prevalence of 25-hydroxyvitamin D deficiency, however, could not be explained by differences in total vitamin D intakes. The consequences of suboptimal 25-hydroxyvitamin D levels were analyzed in 146 patients with diabetic nephropathy. The significant, inverse relationship between serum 25-hydroxyvitamin D and parathyroid hormone levels was attenuated to a nonsignificant level on multivariate adjustment. There was a significant, inverse relationship between bone mineral density and coronary artery calcification scores; neither was independently associated with serum 25-hydroxyvitamin D. The serum 25-hydroxyvitamin D levels declined modestly in 72 patients studied after 12.4 +/- 0.4 mo.Conclusions: 25-Hydroxyvitamin D deficiency is more common in chronic kidney disease, but this higher prevalence is unlikely to be a result of lower vitamin D intakes. The consequences of suboptimal 25-hydroxyvitamin D levels remain to be definitively elucidated.