Hypovitaminosis D in chronic kidney disease.
OBJECTIVE
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.


METHODS
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.
Mehrotra
Rajnish
R
Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA. rmehrotra@labiomed.org
Kermah
Dulcie
D
Budoff
Matthew
M
Salusky
Isidro B
IB
Mao
Sang Shaou
SS
Gao
Yan Lin
YL
Takasu
Junichiro
J
Adler
Sharon
S
Norris
Keith
K
D000328:Adult; D000368:Aged; D015519:Bone Density; D002114:Calcinosis / Q000097:blood / Q000209:etiology; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000209:etiology*
D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D