Associations of plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations with death and progression to maintenance dialysis in patients with advanced kidney disease.
Associations of plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations with death and progression to maintenance dialysis in patients with advanced kidney disease.
复制标题
DOI：
10.1053/j.ajkd.2012.04.014
复制
发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
HOST (Homocysteinemia in Kidney and End Stage Renal Disease) Study Investigators
中科院分区：
文献类型：
--
作者：
Kendrick J;Cheung AK;Kaufman JS;Greene T;Roberts WL;Smits G;Chonchol M;HOST (Homocysteinemia in Kidney and End Stage Renal Disease) Study Investigators
低维生素D浓度在慢性肾病（CKD）患者中普遍存在。我们研究了晚期CKD患者血浆25-羟基维生素D（25（OH）D）或1，25-二羟维生素D（1，25（OH）2D）浓度与死亡、心血管事件（CVE）和透析开始之间的关系。研究设计：同型半胱氨酸研究是一项随机双盲试验，旨在评估高剂量叶酸对晚期CKD患者（尚未接受透析的4期和5期）死亡和慢性透析启动的影响。25（OH）D和1，25（OH）2D浓度在试验开始后3个月获得的储存血浆样品中测量，并分别在临床定义的临界值（<10、10 - 30和> 30 ng/mL）和三分位数（<15、15 - 22和> 22 pg/mL）下进行评价。使用Cox比例风险模型来检查维生素D浓度与临床结果之间的关联。来自36家退伍军人事务医疗中心的1，099例晚期CKD患者25（OH）D和1，25（OH）2D浓度死亡、CVE和至开始慢性透析的时间。中位随访期为2.9年后，41%（n = 453）死亡，56%（n = 615）开始透析。平均25（OH）D和1，25（OH）2D浓度分别为21 ± 10 ng/mL和20 ± 11 pg/mL。校正潜在混杂因素后，与最高三分位数相比，1，25（OH）2D的最低三分位数与死亡（HR，1.33; 95% CI，1.01 - 1.74）和开始慢性透析（HR，1.78; 95% CI，1.40 - 2.26）相关。在调整血浆成纤维细胞生长因子-23（FGF23）浓度后，与死亡和开始透析的相关性中度减弱（与最高三分位数相比，较低三分位数的HR分别为1.20 [95% CI，0.91 - 1.58]和1.56 [95% CI，1.23 - 1.99]）。25（OH）D浓度与结局之间无相关性。参与者大多为男性。低血浆1，25（OH）2D浓度与晚期CKD患者死亡和开始慢性透析相关成纤维细胞生长因子-23可能会减弱这种关系。
Low vitamin D concentrations are prevalent in chronic kidney disease (CKD) patients. We investigated the relationship between plasma 25-hydroxyvitamin D (25(OH)D) or 1,25-dihydroxyvitamin D (1,25(OH)2D) concentrations with death, cardiovascular events (CVE) and dialysis initiation in patients with advanced CKD. Study Design: The Homocysteine Study was a randomized double-blind trial evaluating the effects of high doses of folic acid on death and chronic dialysis initiation in patients with advanced CKD (stage 4 and 5 not yet on dialysis). 25(OH)D and 1,25(OH)2D concentrations were measured in stored plasma samples obtained 3 months after trial initiation and evaluated at clinically defined cutoffs (<10, 10-30, and >30 ng/mL) and tertiles (< 15, 15-22, and >22 pg/mL), respectively. Cox-proportional hazard models were used to examine the association between vitamin D concentrations and clinical outcomes. 1,099 patients with advanced CKD from 36 Veteran Affairs Medical Centers 25(OH)D and 1,25(OH)2D concentrations Death, CVE and time to initiation of chronic dialysis. After a median follow-up period of 2.9 years, 41% (n=453) died, while 56% (n=615) initiated dialysis. Mean 25(OH)D and 1,25(OH)2D concentrations were 21±10 ng/mL and 20±11 pg/mL, respectively. After adjustment for potential confounders, the lowest tertile of 1,25(OH)2D was associated with death (HR, 1.33; 95% CI, 1.01-1.74) and initiation of chronic dialysis (HR, 1.78; 95% CI, 1.40-2.26), compared to the highest tertile. The association with death and initiation of dialysis was moderately attenuated after adjustment for plasma fibroblast growth factor-23 (FGF23) concentrations (HRs of lower tertiles of 1.20 [95% CI, 0.91-1.58] and 1.56 [95% CI, 1.23-1.99], respectively, compared to highest tertile). There was no association between 25(OH)D concentrations and outcomes. Participants were mostly male. Low plasma 1,25(OH)2D concentrations are associated with death and initiation of chronic dialysis in advanced CKD. Fibroblast growth factor-23 may attentuate this relationship.
登录
查看更多内容
DOI：
10.1056/nejmoa0706130
发表时间：
2008-08-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Gutiérrez OM;Mannstadt M;Isakova T;Rauh-Hain JA;Tamez H;Shah A;Smith K;Lee H;Thadhani R;Jüppner H;Wolf M
通讯作者：
Wolf M
影响因子：
13.2
作者：
de Boer, Ian H.;Ioannou, George N.;Weiss, Noel S.
通讯作者：
Weiss, Noel S.
影响因子：
7.1
作者：
Jacques, PF;Felson, DT;Rush, D
通讯作者：
Rush, D
影响因子：
19.6
作者：
Chonchol, M.;Scragg, R.
通讯作者：
Scragg, R.
影响因子：
120.7
作者：
Jamison, Rex L.;Hartigan, Pamela;Gaziano, J. Michael
通讯作者：
Gaziano, J. Michael