A low plasma 1,25(OH) 2 vitamin D/PTH (1–84) ratio predicts worsening of renal function in patients with chronic heart failure

Masson, Serge; Barlera, Simona; Colotta, Francesco; Magnoli, Michela; Bonelli, Fabrizio; Moro, Milena; Marchioli, Roberto; Tavazzi, Luigi; Tognoni, Gianni; Latini, Roberto

doi:10.1016/j.ijcard.2016.09.014

Cited by 13 publications

(8 citation statements)

References 32 publications

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“…On the other hand, Gruson et al showed that 1,25(OH)2D, but not 25(OH)D, correlates with NYHA functional class in chronic heart failure patients, especially that 1,25(OH)2D to PTH(1–84) ratio is a promising predictor of cardiovascular death in HF [ 41 , 42 ]. There are some other reports showing that 25(OH)D deficiency was not related to HF in contrast to PTH [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Parathyroid Hormone and Vitamin D Serum Concentrations in Patients with Cardiovascular Diseases

et al. 2018

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25-hydroxyvitamin D (25(OH)D) plays a crucial role in human homeostasis. Its deficiency (vitamin D deficiency—VDD), being common in European population, combined with elevated concentration of parathyroid hormone (PTH), represents a vicious cycle of mechanisms leading to heart failure (HF). Despite several papers published in that field, the effect of VDD and PTH concentration on cardiovascular system remains unequivocal; thus, the aim of the study was to compare these data among HF and non-HF patients being prospectively enrolled into the study during hospital stay in the cardiology ward. Patients with HF had higher PTH concentration (85.0 ± 52.6 versus 64.5 ± 31.7, p ≤ 0.02) compared to non-HF patients. Mean PTH values were associated with the clinical status expressed by the New York Heart Association class (NYHA class) (“0”—66.04, “I”—56.57, “II”—72.30, “III”—85.59, and “IV”—144.37 pg/ml, p ≤ 0.00004). Interestingly, neither 25(OH)D (31.5 versus 29.7 ng/ml, p ≤ ns) nor phosphorus (P) (1.23 versus 1.18 mmol/l, p ≤ ns) nor total calcium (Ca2+) concentration (2.33 versus 2.37 mmol/l, p ≤ ns) differed among the groups. Reassuming PTH serum concentration in contrary to 25(OH)D, P and Ca2+ are significantly raised among the patients with HF and shows significant relationship with the clinical status expressed by the NYHA class.

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Section: Discussionmentioning

confidence: 99%

The Role of Parathyroid Hormone and Vitamin D Serum Concentrations in Patients with Cardiovascular Diseases

et al. 2018

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“…The consequences of 25[OH]D deficiency [32] and elevated PTH levels [33][34][35][36] are calcium loading, with cardiomyocyte and skeletal muscle contractile dysfunction, cellular hypertrophy, oxidative stress, immune activation, endothelial dysfunction (including enhanced endothelin-1 release) [30,34,[37][38][39][40][41]. These influences are reflected clinically with an increased risk of hospitalisation [7,42], and worsening renal function [43], whilst vitamin D supplementation may be associated with a reduction of plasma renin and aldosterone levels [44,45]. Consistent with these observations, we found lower mean sodium levels and higher mean heart rates in 25[OH]D-deficient heart failure patients.…”

Section: Why Might Vitamin D Be Important In Chronic Heart Failure?mentioning

confidence: 99%

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

et al. 2018

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“…The GISSI-HF trial was a randomized control study, conducted among 6.975 patients with stable heart failure ( 67 ). The study included middle aged patients (66.8 ± 10.8 years) with mild to moderate CKD (eGFR 68.6 + 23.5 ml/min/1.73 m 2 ) ( 29 ). In post-hoc analysis by Masson et al ( 29 ) 335 (29.6%) experienced WRF, defined as ≥0.3 mg/dl and ≥25% increase in sCr at two consecutive study visits during 60-month follow up.…”

Section: Discussionmentioning

confidence: 99%

“…DiaSorin LIAISON® XL analyzer is a validated and fully-automated method, which provides both the-third generation assay for the only biologically active PTH (1–84) whole peptide ( 26 ) and the accurate assessment of 1,25(OH) 2 D ( 27 , 28 ). The 1,25(OH) 2 D/PTH (1–84) ratio, measured by aforementioned assay, independently predicted WRF in heart failure ( 29 ) and CKD stage G3b to G5 patients ( 30 ).…”

Section: Introductionmentioning

confidence: 99%

1,25-dihydroxyvitamin D as Predictor of Renal Worsening Function in Chronic Kidney Disease. Results From the PASCaL-1,25D Study

Galassi¹,

Fasulo²,

Ciceri³

et al. 2022

Front. Med.

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BackgroundHeterogeneous progression of chronic kidney disease (CKD) toward dialysis advocates improving in renal care management. Diagnosis and staging of CKD relies on estimated glomerular filtration rate (eGFR) and albuminuria. Tubular biomarkers emerged as new predictors of worsening renal function (WRF), due to partial inaccuracy of eGFR and existing WRF in non-proteinuric patients. Active vitamin D is synthesized in renal tubules and participates to mineral adaptation in CKD. Circulating 1,25-dihydroxyvitamin D [1,25(OH)2D] was poorly investigated as a biomarker of endocrine tubular function and predictor of WRF.ObjectiveInvestigate capability of 1,25(OH)2D to predict parathormone (PTH) increase and WRF in CKD stage 3–4.MethodsPASCaL-1,25D was an observational, prospective, monocentric study. Primary outcomes were absolute and 20% increase in PTH, and WRF defined as 20% reduction in eGFR or dialysis initiation at 6 months.ResultsSeventy-one patients completed follow up. Absolute increase in PTH (1–84) was independently predicted by lower 1,25(OH)2D levels (p = 0.0134). No association was detected between 1,25(OH)2D and iPTH increase. Higher 1,25(OH)2D was associated with reduced risk of WRF at univariate analysis [OR 0.89 (95% CI 0.86–0.93), p = 0.006]. The 1,25(OH)2D/PTH (1–84) ratio was associated with non-significant 84% risk reduction for WRF [OR 0.16 (95% CI 0.06–0.41), p = 0.05]. Low 1,25(OH)2D reached 100% sensitivity in predicting WRF in CKD stage 3 (AUC 9.909, p < 0.0001) and non-elderly patients (AUC 0.883, p < 0.0001). Machine learning models retained 1,25(OH)2D/PTH (1–84) as relevant predictor of WRF together with eGFR and albuminuria. Age influenced interaction between renal and mineral biomarkers.Conclusion1,25(OH)2D deserves attention as biomarker of tubular health, and sensible predictor of WRF on the short run among non-elderly patients affected by stage 3 CKD. The 1,25(OH)2D/PTH (1–84) ratio may represent a composite biomarker of tubular reserve/endocrine response to the transition from adaptive to maladaptive equilibrium in CKD-MBD.

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A low plasma 1,25(OH) 2 vitamin D/PTH (1–84) ratio predicts worsening of renal function in patients with chronic heart failure

Cited by 13 publications

References 32 publications

The Role of Parathyroid Hormone and Vitamin D Serum Concentrations in Patients with Cardiovascular Diseases

The Role of Parathyroid Hormone and Vitamin D Serum Concentrations in Patients with Cardiovascular Diseases

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

1,25-dihydroxyvitamin D as Predictor of Renal Worsening Function in Chronic Kidney Disease. Results From the PASCaL-1,25D Study

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