Lower serum calcium is independently associated with CKD progression

Abstract

Disturbances in calcium metabolism are common in individuals with chronic kidney disease (CKD), but whether they are associated with subsequent kidney function decline is less clear. In a CKD 3–5 cohort of 15,755 adult citizens of Stockholm with creatinine tests taken during 2006–2011 and concurrent calcium testing at cohort entry, we investigated the association between baseline serum calcium and the subsequent change in estimated glomerular filtration rate (eGFR, by CKD-EPI) decline using linear mixed models. Mean (SD) baseline corrected serum calcium was 9.6 (0.5) mg/dL. Mean (95%-confidence interval [CI]) eGFR decline was −0.82 (−0.90; −0.74) mL/min/1.73 m2/year. In advanced CKD stages, higher baseline serum calcium was associated with less rapid kidney function decline. The adjusted change (95%-CI) in eGFR decline associated with each mg/dL increase in baseline serum calcium was −0.10 (−0.28; 0.26), 0.39 (0.07; 0.71), 0.34 (−0.02; 0.70) and 0.68 (0.36; 1.00) mL/min/1.73 m2/year for individuals in CKD stage 3a, 3b, 4, and 5, respectively. In a subgroup of patients using vitamin D supplements, the association between baseline serum calcium and CKD progression was eliminated, especially in CKD stage 3b and 4. To conclude, in individuals with CKD stage 3b to 5, lower baseline corrected serum calcium, rather than higher baseline serum calcium, associated with a more rapid CKD progression. Lower serum corrected calcium seems to be indicative for vitamin D deficiency.

Association of Mineral Bone Disorder With Decline in Residual Kidney Function in Incident Hemodialysis Patients

“…Our findings showing the association between hyperphosphatemia and poor renal outcome in HD patients are in line with those of previous animal researches and studies of predialysis CKD patients . Interestingly, contrary to intuition that a higher serum calcium concentration would be associated with a rapid decline in RKF, there is some evidence of the association between lower serum calcium and rapid CKD progression among nondialysis patients with CKD . However, the association between serum calcium and decline in RKF was uncertain in HD patients.…”

“…(17,34,35) Interestingly, contrary to intuition that a higher serum calcium concentration would be associated with a rapid decline in RKF, there is some evidence of the association between lower serum calcium and rapid CKD progression among nondialysis patients with CKD. (26,27,39) However, the association between serum calcium and decline in RKF was uncertain in HD patients. In this study, we observed that lower serum calcium levels were associated with more rapid decline in RKF among incident HD patients.…”

“…(22)(23)(24)(25) There is also evidence that low serum calcium may be associated with progression of renal failure associated with vitamin D deficiency. (26)(27)(28)(29) Furthermore, abnormal levels of vitamin D and fibroblast growth factor-23 (FGF-23), factors related to CKD-MBD homeostasis, may also play a role in renal damage. (30,31) Over the last 20 years, there have been many advances in the treatment of CKD-MBD with the goal of decreasing mortality and improving cardiovascular health.…”

Sex Differential Genetic, Biochemical, Electrolytes and Calcium Values Associated with Chronic Kidney Disease

“…All of the study subjects in the present study have shown low serum Ca++. Disorders in calcium metabolism are common in patients with CKD, but whether they are associated with subsequent kidney function deterioration is unclear (Janmaat et al, 2018).…”

“…Polymorphisms of the gene have been linked to gout susceptibility and to hereditary hypouricemia. Familial childhood gout with progressive renal impairment attributable to mutations of the uromodulin (UMOD) gene is associated with reduced uromodulin in the proximal tubule cilia (Janmaat et al, 2018).…”