25-Hydroxyvitamin D Levels, Race, and the Progression of Kidney Disease

Melamed, Michal L.; Astor, Brad C.; Michos, Erin D.; Hostetter, Thomas H.; Powe, Neil R.; Muntner, Paul

doi:10.1681/asn.2009030283

Cited by 173 publications

(149 citation statements)

References 55 publications

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“…This is in line with previous studies (6,42), although others did report an association with renal function loss (43). The relatively small decrease in eGFR during follow-up (217.2 ml/min per 1.73 m 2 [IQR, 226.0 to 210.4]) may explain this negative result; studies with longer follow-up may be needed to further explore this association.…”

Section: Discussionsupporting

confidence: 90%

Plasma Vitamin D Level and Change in Albuminuria and eGFR According to Sodium Intake

Keyzer¹,

Lambers-Heerspink²,

Joosten

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Low circulating 25-hydroxyvitamin D [25(OH)D] and high sodium intake are both associated with progressive albuminuria and renal function loss in CKD. Both vitamin D and sodium intake interact with the renin-angiotensin-aldosterone system. We investigated whether plasma 25(OH)D or 1,25-dihydroxyvitamin D [1,25(OH) 2 D] is associated with developing increased albuminuria or reduced renal function and whether these associations depend on sodium intake.Design, setting, participants, & measurements Baseline plasma 25(OH)D and 1,25(OH) 2 D were measured by liquid chromatography tandem mass spectrometry, and sodium intake was assessed by 24-hour urine collections in the general population-based Prevention of Renal and Vascular End-Stage Disease cohort (n=5051). Two primary outcomes were development of urinary albumin excretion .30 mg/24 h and eGFR (creatinine/cystatin C-based CKD Epidemiology Collaboration) ,60 ml/min per 1.73 m 2 . Participants with CKD at baseline were excluded. In Cox regression analyses, we assessed associations of vitamin D with developing increased albuminuria or reduced eGFR and potential interaction with sodium intake.Results During a median follow-up of 10.4 (6.2-11.4) years, 641 (13%) participants developed increased albuminuria, and 268 (5%) participants developed reduced eGFR. Plasma 25(OH)D was inversely associated with increased albuminuria (fully adjusted hazard ratio [HR] per SD higher, 0.86; 95% confidence interval [95% CI], 0.78 to 0.95; P=0.003) but not reduced eGFR (HR, 0.99; 95% CI, 0.87 to 1.12; P=0.85). There was interaction between 25(OH)D and sodium intake for risk of developing increased albuminuria (P interaction =0.03). In participants with high sodium intake, risk of developing increased albuminuria was inversely associated with 25(OH)D (lowest versus highest quartile: adjusted HR, 1.81; 95% CI, 1.20 to 2.73, P,0.01), whereas this association was nonsignificant in participants with low sodium intake (HR, 1.29; 95% CI, 0.94 to 1.77; P=0.12). Plasma 1,25(OH) 2 D was not significantly associated with increased albuminuria or reduced eGFR.Conclusions Low plasma 25(OH)D is associated with higher risk of developing increased albuminuria, particularly in individuals with high sodium intake, but not of developing reduced eGFR. Plasma 1,25(OH)2D is not associated with risk of developing increased albuminuria or reduced eGFR.

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Section: Discussionsupporting

confidence: 90%

Plasma Vitamin D Level and Change in Albuminuria and eGFR According to Sodium Intake

Keyzer¹,

Lambers-Heerspink²,

Joosten

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…This finding is consistent with the results of other studies 43,44 and may be related to increased skin pigmentation, which reduces the skin's ability to synthesize activated vitamin D. 45 The number of African American patients in this study is reflective of the hospital's urban Detroit population. According to data from the National Health and Nutrition Examination Survey, nonHispanic blacks and Mexican Americans are more likely to be at risk for vitamin D deficiency than are other races after adjustments are made for season and age.…”

Section: Financial Disclosures None Reportedsupporting

confidence: 92%

Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

Rech

Hunsaker

Rodriguez

2014

American Journal of Critical Care

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Background Vitamin D has immunomodulating properties. Objective To determine if vitamin D deficiency within 30 days of admission to the intensive care unit in patients with sepsis might be associated with increased all-cause 30-day mortality. Methods In a retrospective cohort study at a large, tertiary, urban, academic medical center, records of patients who had 25-hydroxyvitamin D levels measured within 30 days of admission for severe sepsis or septic shock from June 2006 to April 2011 were examined. Patients were considered deficient in vitamin D if its serum concentration was 15 ng/mL or less. The primary outcome of interest was 30-day mortality. Results Among the 121 patients in the sample, 65 (54%) were vitamin D deficient. Baseline demographics were similar between vitamin D deficient and nondeficient groups, except that the vitamin D deficient group had more African Americans (P = .01). All-cause 30-day mortality was significantly higher in patients deficient in vitamin D (37% vs 20%; P = .04) and remained higher at 90 days (51% vs 25%, P = .005). In multivariate analysis, age (odds ratio, 1.04; 95% CI 1.01–1.07; P = .01) and vitamin D deficiency (odds ratio, 2.7; 95% CI, 1.39–18.8; P = .02) were independently associated with increased 30-day mortality. Conclusion Patients deficient in vitamin D within 30 days of hospital admission for severe sepsis or septic shock may be at increased risk for all-cause 30-day mortality.

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“…1,25(OH)D is less commonly measured than is 25(OH)D. Indeed, 1,25(OH)D status has not been assessed in most studies demonstrating a link between vitamin D deficiency and important clinical endpoints, including cardiovascular disease, 39 mortality, 40 certain types of cancer, 41 and, of note, ESRD 18 and GFR decline. 19 Because 25 (OH)D and 1,25(OH)D were systematically measured in this study, we could discriminate the relative association of these two measures with renal outcome.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15] More recently, calcitriol and paricalcitol, two agonists of VDR signaling, have been shown to lessen albuminuria in patients with IgA nephropathy 16 and diabetic nephropathy, 17 respectively. In addition, two community-based studies and a small observational study in patients with CKD who have not had transplantation found an association between low 25(OH)D levels and the risk of ESRD 18 or eGFR decline. 19 Transplant recipients frequently have low 25(OH)D and 1,25(OH)D levels, especially early after transplantation.…”

mentioning

confidence: 99%

Vitamin D Status and Outcomes After Renal Transplantation

Bienaimé

Girard

Anglicheau

et al. 2013

Journal of the American Society of Nephrology

100

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Kidney transplant recipients usually have low vitamin D levels, especially in the early posttransplantation period, but the association between vitamin D status with renal outcomes is not well described in this population. Here, we studied a prospective cohort of 634 kidney recipients who underwent transplantation at a single institution between January 2005 and June 2010. In this cohort, low 25-hydroxyvitamin D concentrations 3 months after transplantation did not predict early death or graft loss but were independently associated with lower measured GFR at 12 months (P=0.001) and higher risk for interstitial fibrosis and tubular atrophy (P=0.01). In contrast, levels of calcium, phosphorus, calcitriol, parathyroid hormone, or fibroblast growth factor-23 were not consistently associated with any of the studied outcomes. In conclusion, low 25-hydroxyvitamin D concentration measured 3 months after transplantation is an independent risk factor for interstitial fibrosis progression and is associated with a lower GFR 1 year after transplantation. 24: 831-841, 201324: 831-841, . doi: 10.1681 Kidney transplantation is the preferred treatment for the increasing number of patients with ESRD. Transplantation allows patients to avoid the heavy constraints associated with dialysis therapy and is associated with a lower mortality and morbidity than is hemodialysis. 1 Evolution of GFR in transplant recipients appears to be imprinted at an early stage after the surgery. Indeed, the estimated GFR (eGFR) reached 1 year after transplantation is critically associated with allograft outcome. 2,3 This observation prompts research on modifiable factors affecting GFR in the first year after transplantation. J Am Soc NephrolVitamin D is a critical hormone controlling mineral homeostasis. It promotes phosphate and calcium absorption by the gut and increases calcium reabsorption by the renal distal tubule, thereby providing the positive calcium and phosphorus flux required for bone mineralization.

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25-Hydroxyvitamin D Levels, Race, and the Progression of Kidney Disease

Cited by 173 publications

References 55 publications

Plasma Vitamin D Level and Change in Albuminuria and eGFR According to Sodium Intake

Plasma Vitamin D Level and Change in Albuminuria and eGFR According to Sodium Intake

Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

Vitamin D Status and Outcomes After Renal Transplantation

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