title: 25 (OH) vitamin D levels and renal disease progression in patients with type 2 diabetic nephropathy and blockade of the renin-angiotensin system.
abstract: OBJECTIVE
  Experimental studies show that 25 (OH) vitamin D is a suppressor of renin biosynthesis and that vitamin D deficiency has been associated with CKD progression. Patients with type II diabetes and CKD have an exceptionally high rate of severe 25 (OH) vitamin D deficiency; however, it is not known whether this deficiency is a risk factor for progression of diabetic nephropathy. This study aimed to investigate whether there is an association of 25 (OH) vitamin D deficiency with disease progression in type II diabetic nephropathy.
  
  
  METHODS
  25 (OH) vitamin D levels were measured at baseline and 4 and 12 months in 103 patients included in a multicenter randomized controlled trial to compare the efficacy of combining an angiotensin-converting enzyme inhibitor and an angiotensin receptor blocker with the efficacy of each drug in monotherapy to slow progression of established diabetic nephropathy during 2006-2011. The primary composite endpoint was a >50% increase in baseline serum creatinine, ESRD, or death. All study participants were included in the analysis.
  
  
  RESULTS
  Fifty-three patients (51.5%) had 25 (OH) vitamin D deficiency (<15 ng/ml). After a median follow-up of 32 months, the endpoint was reached by 23 patients with deficiency (43.4%) and 8 patients without (16%). Multivariate Cox regression analysis adjusted for urinary protein/creatinine ratio, estimated GFR, and baseline aldosterone showed that 25 (OH) vitamin D deficiency was associated with the primary endpoint (hazard ratio, 2.88; 95% confidence interval, 1.84 to 7.67; P=0.04).
  
  
  CONCLUSIONS
  These results show that 25 (OH) vitamin D deficiency is independently associated with a higher risk of the composite outcome in patients with type II diabetic nephropathy.
authors.affiliation: Alcorcón Hospital Foundation, Alcorcón, Spain;, †Gregorio Marañón University General Hospital, Madrid, Spain;, ‡Infanta Sofia Hospital, Madrid, Spain;, §12 de Octubre University Hospital, Madrid, Spain;, ‖Complutense University of Madrid, Madrid, Spain, ¶National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Juárez
authors.forename: José
authors.initials: J
authors.lastname: Luño
authors.forename: Vicente
authors.initials: V
authors.lastname: Barrio
authors.forename: Soledad García
authors.initials: SG
authors.lastname: de Vinuesa
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.forename: Marian
authors.initials: M
authors.lastname: Goicoechea
authors.forename: Vicente
authors.initials: V
authors.lastname: Lahera
authors.forename: Luisa
authors.initials: L
authors.lastname: Casas
authors.forename: Jesús
authors.initials: J
authors.lastname: Oliva
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D014807:Vitamin D; D000450:Aldosterone; C104450:25-hydroxyvitamin D; D003404:Creatinine