Disturbances of parathyroid hormone–vitamin D axis in non-cholestatic chronic liver disease: a cross-sectional study

Abstract

Purpose Liver has an important role in metabolism of vitamin D. This study aimed to evaluate the patterns of vitamin D-parathyroid hormone (PTH) disturbance and correlate it in patients with non-cholestatic chronic liver disease (CLD). Methods A total of 40 healthy controls and 90 consecutive patients with evidence of non-cholestatic CLD due to hepatitis C (n = 28), hepatitis B (n = 26), autoimmune hepatitis (n = 19), and cryptogenic causes (n = 17) were enrolled. Cirrhosis was evident in 51 patients. Serum concentrations of 25-hydroxy vitamin D, PTH, calcium, phosphate, and liver enzymes were measured. Child-Pugh classification was determined in cirrhotic patients. Results Vitamin D deficiency (\50 nmol/l) was found in 46 (51.1%) patients and vitamin D insufficiency (50-80 nmol/l) in 15 (16.7%) patients. Secondary hyperparathyroidism (serum PTH [ 6.8 pmol/l) was present in 6 (6.7%) patients. The prevalence of vitamin D deficiency was significantly higher in cirrhotic versus noncirrhotic patients (76.5 vs. 17.9%; P \ 0.001), whereas there was no significant difference in serum calcium, phosphate, and PTH levels. ChildPugh class B and C patients had significantly lower vitamin D level compared with class A patients (P \ 0.001), whereas there was no significant difference in serum calcium, phosphate, and PTH levels. No significant correlation was seen between vitamin D and PTH, calcium or phosphate levels. Lower serum level of vitamin D was associated with coagulopathy, hyperbilirubinemia, hypoalbuminemia, anemia, and thrombocytopenia. Conclusions Vitamin D inadequacy and the severity of liver dysfunction move in parallel in patients with noncholestatic CLD. Vitamin D assessment and replacement should be considered in the management of patients with non-cholestatic CLD.

Does Vitamin D Level Affect the Response to Antiviral Treatment in Egyptian Patients with Chronic Hepatitis C?

“…These results are in agreement with other studies (17,18,19) on (8). Other studies demonstrated the lower serum vitamin D levels, the higher the degree of inflammation and/or stage of fibrosis in chronic HCV patients (15,20,21,22). Arteh et al (23) reported that vitamin D <32 ng/mL was detected in 92% of 118 patients with CLD.…”

“…Miroliaee et al (15) demonstrated that cirrhotic patients had lower vitamin D levels than non-cirrhotic patients. Lower vitamin D levels were detected in patients with Child-Pugh class B and C compared to those with class A (p<0.001) while the difference in levels of serum vitamin D between healthy controls and non-cirrhotic patients was not significant (95.28±29.41 and 81.37±30.44 nmol/L, respectively).…”

Calcium plus vitamin D supplementation affects pregnancy outcomes in gestational diabetes: randomized, double-blind, placebo-controlled trial

“…In agreement with our study, oral Ca supplementation resulted in a significant decrease in serum bilirubin in patients with Crigler-Najjar type I (32) . Furthermore, Miroliaee et al (33) found that lower serum levels of vitamin D were associated with hyperbilirubinaemia in patients with non-cholestatic chronic liver disease. Fisher and Fisher (34) have also shown that serum vitamin D levels of less than 25 nmol/l could be a reliable predictor of higher serum bilirubin.…”

Nutrition in the Management of Cirrhosis and its Neurological Complications

“…Chronic liver disease commonly results in vitamin D deficiency. [25][26][27][28] In particular, a large proportion of patients with alcoholic liver disease have compromised vitamin D status. 29 Vitamin D deficiency has also been linked to poor outcomes in patients with hepatitis C. Recently, it was demonstrated that extremely low serum levels of vitamin D are associated with increased mortality in patients with chronic liver disease 30 and the authors speculated that an impaired immune function due to vitamin D deficiency could explain this observation.…”