Vitamin D levels in subjects with or without chronic kidney disease among Veterans with diabetes in North East United States

Abstract

AIMTo evaluate the prevalence of vitamin D deficiency and its relation to diabetes and kidney disease in Veterans residing in the North East United States (VISN 2).METHODSIn this retrospective study, we used data from the computerized patient record system at Stratton Veterans Administration Medical Center at Albany, NY (VHA) for those patients who had 25-hydroxyvitamin D levels and 1,25 (OH) vitamin D levels measured between 2007 and 2010. We collected demographic information including age, sex, body mass index and race; clinical data including diabetes, hypertension and CAD; and laboratory data including calcium, creatinine and parathyroid hormone (PTH) (intact). Vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng/mL (50 nmol/L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng/mL (50 to 75 nmol/L).RESULTSData was available for approximately 68000 subjects. We identified 64144 subjects for analysis after exclusion of duplicates. Among them, 27098 had diabetes. The mean age of subjects with diabetes was 68 ± 11 with a mean body mass index (BMI) of 32 ± 7 and duration of diabetes of 5.6 ± 3.2 years. The mean 25 (OH) vitamin D level among subjects with diabetes was 27 ± 11.6. There was no significant difference in 25 (OH) vitamin D levels between subjects with diabetes and glomerular filtration rate (e-GFR) < 60 compared to those with e-GFR ≥ 60. As expected, subjects with e-GFR < 60 had significantly lower 1,25 (OH) vitamin D levels and significantly elevated PTH-intact. Of the 64144 subjects, 580 had end-stage renal disease. Of those, 407 had diabetes and 173 did not. Vitamin D levels in both groups were in the insufficiency range and there was no significant difference irrespective of presence or absence of diabetes. Subjects with vitamin D levels less than 20 ng/mL had a higher BMI and elevated PTH, and higher HbA1C levels compared to those with vitamin D levels more than 20 ng/mL.CONCLUSIONWe conclude that we need to keep a close eye on vitamin D levels in subjects with mild chronic kidney disease as well as those with moderate control of diabetes.

Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients

“…Moreover, in a retrospective study executed by Sipahi et al that registered 1463 patients with type 2 diabetes mellitus and chronic kidney disease, 52.0% of the subjects had vitamin D deficiency and 24.0% presented with vitamin insufficiency [ 73 ]. However, a study by Yaturus et al showed insufficient levels of vitamin D levels in both diabetic and non-diabetic patients with chronic renal failure and no-significant difference between the two groups [ 75 ].…”

<p>Correlation Between Parathyroid Hormone Levels with Urinary Magnesium Excretion in Patients with Non-Dialysis Dependent Chronic Kidney Disease</p>

“…35 The prevalence of 25(OH)D deficiency is common in CKD and is implicated in the progressive increase in PTH, which is observed with declining renal function and leads to secondary hyperparathyroidism, bone mineral disease and increased cardiovascular risk. 41 In the study, no correlation between PTH and 25(OH)D was observed. This result is similar to that observed by Cuppari et al, 42 in a cohort that involved 144 patients with CKD who did not yet receive dialysis (CKD stages 2 to 5), demonstrated that the 25 (OH) D levels were not associated with PTH.…”

Lower serum 25-hydroxyvitamin D levels are associated with impaired glomerular filtration rate in type 2 diabetes patients

“…When analyzing eGFR, some studies described a direct interaction between 25(OH)D and GFR, 15 , 16 whereas other authors did not confirm this finding. 7 , 8 , 12 , 15 , 18 , 27 As we and others have previously demonstrated, the accuracy of GFR estimated by equations is poor, especially in patients with diabetes, markedly underestimating true GFR. 21 , 28 – 30 This finding is probably due to either analytical factors, such as interference of glucose levels on creatinine measurement, or to the lack of sensitivity of creatinine to identify glomerular hyperfiltration, a peculiar scenario in diabetes.…”