title: Vitamin D deficiency, parathyroid hormone levels, and bone disease among patients with end-stage liver disease and normal serum creatinine awaiting liver transplantation.
abstract: Vitamin D deficiency is common among patients with end-stage liver disease (ESLD). The primary aim of our study was to assess the prevalence of vitamin D deficiency, secondary hyperparathyroidism, and bone disease in patients with ESLD awaiting LT.
  
  
  METHODS
  We retrospectively studied 190 patients at our center. Serum total 25-hydroxyvitamin D (25-OH D), parathyroid hormone (PTH), calcium, and bone mineral analysis (BMA) were recorded. Standard World Health Organization (WHO) criteria were used to diagnose osteopenia/osteoporosis. Only patients with normal serum creatinine were analyzed.
  
  
  RESULTS
  Thirty-two of 190 patients were excluded from the final analysis (missing serum total 25-OH D levels in three patients and elevated serum creatinine, 29 patients). 105 of 158 (66.4%) evaluable patients had 25-OH D levels <25 ng/mL. Patients included in the analysis (n = 158) were divided according to serum total 25-OH D levels: 0-10 ng/mL (n = 23), 11-20 ng/mL (n = 64), and >20 ng/mL (n = 71). There were no significant differences in mean serum PTH and corrected calcium levels among the three subgroups. Only three patients had elevated serum PTH. Patients with total 25-OH D ≤ 10 ng/mL had higher model for end-stage liver disease (MELD) scores vs. those with 25-OH D > 20 ng/mL (13.3 ± 3, range 8-21, vs. 11.9 ± 3.4, range 6-29, p = 0.004). Irrespective of vitamin D status, bone disease was present in 64.6% of patients.
  
  
  CONCLUSIONS
  Low vitamin D levels and bone disease are common among patients with ESLD awaiting LT. Despite a high prevalence of low serum total 25-OH D, our cohort maintained normal corrected calcium levels and did not develop secondary hyperparathyroidism. We propose that free serum 25-OH D and vitamin D-binding protein may be necessary to accurately establish the diagnosis of vitamin D deficiency in the setting of ESLD. Additional studies are needed to further define mechanisms of bone disease in patients with ESLD.
authors.affiliation: Transplantation Center, Mayo Clinic Hospital, Phoenix, AZ, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Corey
authors.forename: Michael D
authors.initials: MD
authors.lastname: Whitaker
authors.forename: Michael D
authors.initials: MD
authors.lastname: Crowell
authors.forename: Mira T
authors.initials: MT
authors.lastname: Keddis
authors.forename: Bashar
authors.initials: B
authors.lastname: Aqel
authors.forename: Vijayan
authors.initials: V
authors.lastname: Balan
authors.forename: Thomas
authors.initials: T
authors.lastname: Byrne
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carey
authors.forename: David D
authors.initials: DD
authors.lastname: Douglas
authors.forename: M Edwyn
authors.initials: ME
authors.lastname: Harrison
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Vargas
authors.forename: Jorge
authors.initials: J
authors.lastname: Rakela
mesh_terms: D001847:Bone Diseases / Q000453:epidemiology*; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood*; D058625:End Stage Liver Disease / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology*; D014850:Waiting Lists
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D003404:Creatinine; D002118:Calcium
keywords: chronic liver disease; osteoporosis; secondary hyperparathyroidism; total 25-OH vitamin D; vitamin D-binding protein