title: A low plasma 1,25(OH)2vitamin D/PTH (1-84) ratio predicts worsening of renal function in patients with chronic heart failure.
abstract: BACKGROUND
  Dysregulation of the vitamin D system promotes renal dysfunction and has direct detrimental effects on the heart. Progressive deterioration of renal function is common in patients with chronic heart failure (HF) and is invariably associated with unfavorable outcomes which can be improved by early identification and timely interventions. We examined the relation between two plasma markers of vitamin D metabolism and worsening of renal function (WRF) in a large cohort of patients with chronic HF.
  
  
  METHODS
  Plasma levels of 1,25-dihydroxyvitamin D (1,25(OH)2D) and parathyroid hormone PTH (1-84) were measured in 1237 patients with clinical evidence of chronic and stable HF enrolled in the multicentre GISSI-HF trial and followed for 3.9years. We examined the relation of 1,25(OH)2D, PTH(1-84), and their ratio with WRF, defined as first increase in serum creatinine concentration ≥0.3mg/dL and ≥25% at two consecutive measurements at any time during the study.
  
  
  RESULTS
  Lower 1,25(OH)2D/PTH(1-84) ratio was associated with a higher baseline serum concentration of creatinine, winter season, female sex and older age; 335 patients (29.6%) experienced an episode of WRF. After adjustment, a lower 1,25(OH)2D/PTH(1-84) ratio remained significantly associated with a higher risk of WRF (HR=0.75 [0.62-0.90], p=0.002) and correctly reclassified events. This ratio also independently predicted mortality and admission to hospital for cardiovascular reasons.
  
  
  CONCLUSIONS
  The plasma 1,25(OH)2D/PTH(1-84) ratio is a promising indicator of future risk of deterioration of renal function in patients with chronic HF and mild renal impairment, that may serve to optimize therapies and improve outcomes.
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy. Electronic address: serge.masson@marionegri.it.
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.affiliation: DiaSorin SpA, Saluggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Colotta
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Magnoli
authors.affiliation: DiaSorin Inc., Stillwater, MN, USA.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bonelli
authors.affiliation: DiaSorin SpA, Saluggia, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Moro
authors.affiliation: Therapeutic Science & Strategy Unit (TSSU), Quintiles, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marchioli
authors.affiliation: Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D007677:Kidney Function Tests / Q000639:trends; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010281:Parathyroid Hormone / Q000097:blood*; D011237:Predictive Value of Tests; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D
keywords: 1,25-dihydroxyvitamin D; Heart failure; Parathyroid hormone; Worsening renal function