Article

Serum 25-hydroxyvitamin D and change in estimated glomerular filtration rate.

Department of Medicine, University of Washington, Seattle, WA 98195, USA. Tele
Clinical Journal of the American Society of Nephrology (impact factor: 5.23). 08/2011; 6(9):2141-9. DOI:10.2215/CJN.02640311 pp.2141-9
Source: PubMed

ABSTRACT Mounting evidence suggests that 1,25-dihydroxyvitamin D prevents the progression of chronic kidney disease (CKD). It is not clear whether "nutritional" forms of vitamin D affect GFR.
We tested whether serum 25-hydroxyvitamin D concentration (25(OH)D), a measure of total vitamin D intake from cutaneous synthesis and dietary consumption, is associated with loss of estimated GFR among 1705 older adults with predominantly normal baseline kidney function participating in the Cardiovascular Health Study. Baseline 25(OH)D was measured by HPLC-tandem mass spectrometry. GFR was estimated at baseline and 4 years later using the CKD-EPI formula, with rapid GFR loss defined as 12 ml/min per 1.73 m(2) or more over 4 years.
Rapid GFR loss was observed for 207 participants (12%). Each 10 ng/ml lower 25(OH)D was associated with a 25% greater risk of rapid GFR loss (95% confidence interval [CI] 5%, 49%, P = 0.01), adjusting for potential confounding characteristics. Compared with 25(OH)D ≥30 ng/ml, 25(OH)D concentrations 15 to 29 ng/ml and <15 ng/ml were associated with 29% (95% CI -13%, 91%) and 68% (95% CI 1%, 177%) greater adjusted risks of rapid GFR loss, respectively. Magnitudes of association were largest among participants with diabetes.
were similar evaluating a composite outcome of rapid GFR loss, end stage renal disease, and death. Conclusions Insufficient 25(OH)D may be a modifiable risk factor for early GFR loss. We recommend clinical trials to determine whether vitamin D supplementation prevents the development and progression of CKD.

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  • Article: Reduction of the vitamin D hormonal system in kidney disease is associated with increased renal inflammation.
    Daniel Zehnder, Marcus Quinkler, Kevin S Eardley, Rosemary Bland, Julia Lepenies, Susan V Hughes, Neil T Raymond, Alexander J Howie, Paul Cockwell, Paul M Stewart, Martin Hewison
    [show abstract] [hide abstract]
    ABSTRACT: To examine any potential role for 1,25-dihydroxyvitamin D (1,25(OH)2D) in inflammation associated with chronic kidney disease we measured vitamin D metabolites, markers of inflammation and gene expression in 174 patients with a variety of kidney diseases. Urinary MCP-1 protein and renal macrophage infiltration were each significantly but inversely correlated with serum 1,25(OH)2D levels. Logistic regression analysis with urinary MCP-1 as binary outcome showed that a 10-unit increase in serum 1,25(OH)2D or 25OHD resulted in lower renal inflammation. Analysis of 111 renal biopsies found that renal injury was not associated with a compensatory increase in mRNA for the vitamin D-activating enzyme 25-hydroxyvitamin D-1alpha-hydroxylase (CYP27B1), its catabolic counterpart 24-hydroxylase, or the vitamin D receptor. There was, however, a significant association between tissue MCP-1 and CYP27B1. Patients with acute renal inflammation had a significant increase in urinary and tissue MCP-1, macrophage infiltration, and macrophage and renal epithelial CYP27B1 expression but significantly lower levels of serum 1,25(OH)2D in comparison to patients with chronic ischemic disease despite similar levels of renal damage. In vitro, 1,25(OH)2D attenuated TNFalpha-induced MCP-1 expression by human proximal tubule cells. Our study indicates that renal inflammation is associated with decreased serum vitamin D metabolites and involves activation of the paracrine/autocrine vitamin D system.
    Kidney International 10/2008; 74(10):1343-53. · 6.61 Impact Factor
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Keywords

1,25-dihydroxyvitamin D
 
25% greater risk
 
Cardiovascular Health Study
 
chronic kidney disease
 
CKD-EPI formula
 
clinical trials
 
composite outcome
 
Conclusions Insufficient 25(OH)D
 
diabetes
 
end stage renal disease
 
GFR loss
 
HPLC-tandem mass spectrometry
 
modifiable risk factor
 
Mounting evidence
 
normal baseline kidney function
 
Rapid GFR loss
 
serum 25-hydroxyvitamin D concentration
 
total vitamin D intake
 
vitamin D
 
vitamin D supplementation
 

Ian H de Boer