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Elevations in parathyroid hormone (PTH) level have been associated with adverse clinical outcomes, including cardiovascular disease and mortality. 1,2 Loop diuretics have been linked to increased PTH levels in patients with chronic kidney disease (CKD), 3,4 but this association has not been investigated in the general population. We used data from the National Health and Nutrition Examination Survey (NHANES) 5,6 to test the hypothesis that loop diuretic use associates with elevated PTH in adults with preserved renal function.| We studied participants from NHANES 2003 to 2004 5 and 2005 to 2006 6 because PTH measurements were available in these years. Participants were excluded for age younger than 18 years, estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m 2 (using the CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration] equation), or missing PTH value. "Loop users" had prescriptions for furosemide, bumetanide, or torsemide. Baseline characteristics of loop users and nonusers were compared using t tests or χ 2 tests. A multivariable linear regression model was constructed to test the association between loop use and natural log-transformed PTH level. Covariates were age, sex, body mass index (BMI), history of congestive heart failure Letters jamainternalmedicine.com
Elevations in parathyroid hormone (PTH) level have been associated with adverse clinical outcomes, including cardiovascular disease and mortality. 1,2 Loop diuretics have been linked to increased PTH levels in patients with chronic kidney disease (CKD), 3,4 but this association has not been investigated in the general population. We used data from the National Health and Nutrition Examination Survey (NHANES) 5,6 to test the hypothesis that loop diuretic use associates with elevated PTH in adults with preserved renal function.| We studied participants from NHANES 2003 to 2004 5 and 2005 to 2006 6 because PTH measurements were available in these years. Participants were excluded for age younger than 18 years, estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m 2 (using the CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration] equation), or missing PTH value. "Loop users" had prescriptions for furosemide, bumetanide, or torsemide. Baseline characteristics of loop users and nonusers were compared using t tests or χ 2 tests. A multivariable linear regression model was constructed to test the association between loop use and natural log-transformed PTH level. Covariates were age, sex, body mass index (BMI), history of congestive heart failure Letters jamainternalmedicine.com
Essential hypertension has been associated with disturbed calcium metabolism, but the available data are controversial. We measured parameters of calcium metabolism in groups of untreated male subjects (n = 78) with elevated diastolic blood pressure (101 +/- 6 mmHg, mean +/- SD) and age-matched male subjects (n = 79) with low diastolic blood pressure (62 +/- 4 mmHg). The participants of the study were drawn from a random population sample. Subjects with high diastolic blood pressure had significantly higher carboxy-terminal parathyroid hormone (PTH) plasma concentrations than controls with low diastolic blood pressure (median 114 vs. 43 pmol/l, P less than 0.01). The 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations were comparable in both groups. Individuals with high diastolic blood pressure had significantly lower total serum calcium (2.41 +/- 0.10 vs. 2.47 +/- 0.10 mmol/l, mean +/- SD; P less than 0.01). PTH concentrations were correlated with diastolic pressure (r = -0.39, P less than 0.001). The data are compatible with increased parathyroid activity despite unchanged concentrations of vitamin D metabolites in human hypertension.
PurposeAdverse drug reactions as well as vitamin D deficiency are issues of public health concern in older people. However, relatively little is known about the impact of drug use on vitamin D status. Our primary aim is to explore associations between drug use and vitamin D status in older people. Furthermore, prevalences of drug use and vitamin D deficiency are estimated.MethodsIn a population of 873 community-dwelling Dutch geriatric outpatients, we explored the cross-sectional relationships of polypharmacy (≥5 medications concomitantly used), severe polypharmacy (≥10 medications), and use of twenty-one specific drug groups, with serum 25-hydroxyvitamin D (25(OH)D) by analysis of covariance.ResultsOverall prevalence of polypharmacy was 65 %, of severe polypharmacy 22 %. Depending on the cut-off value, prevalence of vitamin D deficiency was 49 % (<50 nmol/l) or 77 % (<75 nmol/l). Of the patients using a vitamin D supplement, 17 % (<50 nmol/l) or 49 % (<75 nmol/l) were still deficient. In non-users of supplemental vitamin D, after adjustment for age and gender, negative associations were found for severe polypharmacy, metformin, sulphonamides and urea derivatives (SUDs), vitamin K antagonists, cardiac glycosides, loop diuretics, potassium-sparing diuretics, ACE inhibitors, and serotonin reuptake inhibitors; for non-selective monoamine reuptake inhibitors (NSMRIs) the association was positive. The most extreme impacts of drug use on adjusted mean 25(OH)D were −19 nmol/l for SUDs and +18 nmol/l for NSMRIs.ConclusionDrug use should be considered a risk factor for vitamin D deficiency amongst geriatric outpatients.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-016-2016-2) contains supplementary material, which is available to authorized users.
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