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Bone mineral metabolism and its relationship to kidney disease in a residential care home population: a cross-sectional study.
Nephrol Dial Transplant. 2008 Nov; 23(11):3554-65.ND

Abstract

BACKGROUND

Institutionalized older people have a high risk of bone fractures due to osteoporosis. In addition, chronic kidney disease (CKD) is highly prevalent in older people living in residential homes. Secondary hyperparathyroidism, poor calcium intake and deficiency of 1,25-dihydroxyvitamin D may lead to decreased bone mass in people with CKD. The present cross-sectional study assessed the relationship between markers of bone mineral metabolism and kidney function in a residential care home population.

METHODS

Older subjects were recruited from residential care homes and kidney function stratified by the estimated glomerular filtration rate (GFR). Parathyroid hormone (PTH), 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured in 188 residents not receiving vitamin D/calcium treatment [mean age 85 (range 68- 100) years, 75% female] and in 52 residents receiving vitamin D/calcium supplementation.

RESULTS

Amongst those not receiving vitamin D/calcium, median PTH increased with declining GFR (P < 0.0001), particularly as GFR (mL/min/1.73 m(2)) fell below 45. PTH concentration was suppressed by increasing 25-hydroxyvitamin D (P < 0.0001), but not 1,25-dihydroxyvitamin D (P > 0.05) concentration. Nearly all residents (92%) had 25-hydroxyvitamin D deficiency or insufficiency and this was uninfluenced by kidney function (P > 0.05). Concentration of 1,25-dihydroxyvitamin D declined with worsening renal function (P < 0.0004) but 1,25-dihydroxyvitamin D deficiency was prevalent at all stages of kidney disease, including amongst residents receiving vitamin D/calcium supplementation.

CONCLUSION

Vitamin D deficiency and secondary hyperparathyroidism are common in this population irrespective of renal function. However, as GFR falls below 45, the prevalence of secondary hyperparathyroidism and 1,25-dihydroxyvitamin D deficiency increases. Unidentified CKD appears to exacerbate secondary hyperparathyroidism in this at risk population.

Authors+Show Affiliations

Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Canterbury, Kent, UK. joanne.carter@ekht.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18544628

Citation

Carter, Joanne L., et al. "Bone Mineral Metabolism and Its Relationship to Kidney Disease in a Residential Care Home Population: a Cross-sectional Study." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 23, no. 11, 2008, pp. 3554-65.
Carter JL, O'Riordan SE, Eaglestone GL, et al. Bone mineral metabolism and its relationship to kidney disease in a residential care home population: a cross-sectional study. Nephrol Dial Transplant. 2008;23(11):3554-65.
Carter, J. L., O'Riordan, S. E., Eaglestone, G. L., Delaney, M. P., & Lamb, E. J. (2008). Bone mineral metabolism and its relationship to kidney disease in a residential care home population: a cross-sectional study. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 23(11), 3554-65. https://doi.org/10.1093/ndt/gfn302
Carter JL, et al. Bone Mineral Metabolism and Its Relationship to Kidney Disease in a Residential Care Home Population: a Cross-sectional Study. Nephrol Dial Transplant. 2008;23(11):3554-65. PubMed PMID: 18544628.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bone mineral metabolism and its relationship to kidney disease in a residential care home population: a cross-sectional study. AU - Carter,Joanne L, AU - O'Riordan,Shelagh E, AU - Eaglestone,Gillian L, AU - Delaney,Michael P, AU - Lamb,Edmund J, Y1 - 2008/06/10/ PY - 2008/6/12/pubmed PY - 2009/3/3/medline PY - 2008/6/12/entrez SP - 3554 EP - 65 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 23 IS - 11 N2 - BACKGROUND: Institutionalized older people have a high risk of bone fractures due to osteoporosis. In addition, chronic kidney disease (CKD) is highly prevalent in older people living in residential homes. Secondary hyperparathyroidism, poor calcium intake and deficiency of 1,25-dihydroxyvitamin D may lead to decreased bone mass in people with CKD. The present cross-sectional study assessed the relationship between markers of bone mineral metabolism and kidney function in a residential care home population. METHODS: Older subjects were recruited from residential care homes and kidney function stratified by the estimated glomerular filtration rate (GFR). Parathyroid hormone (PTH), 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured in 188 residents not receiving vitamin D/calcium treatment [mean age 85 (range 68- 100) years, 75% female] and in 52 residents receiving vitamin D/calcium supplementation. RESULTS: Amongst those not receiving vitamin D/calcium, median PTH increased with declining GFR (P < 0.0001), particularly as GFR (mL/min/1.73 m(2)) fell below 45. PTH concentration was suppressed by increasing 25-hydroxyvitamin D (P < 0.0001), but not 1,25-dihydroxyvitamin D (P > 0.05) concentration. Nearly all residents (92%) had 25-hydroxyvitamin D deficiency or insufficiency and this was uninfluenced by kidney function (P > 0.05). Concentration of 1,25-dihydroxyvitamin D declined with worsening renal function (P < 0.0004) but 1,25-dihydroxyvitamin D deficiency was prevalent at all stages of kidney disease, including amongst residents receiving vitamin D/calcium supplementation. CONCLUSION: Vitamin D deficiency and secondary hyperparathyroidism are common in this population irrespective of renal function. However, as GFR falls below 45, the prevalence of secondary hyperparathyroidism and 1,25-dihydroxyvitamin D deficiency increases. Unidentified CKD appears to exacerbate secondary hyperparathyroidism in this at risk population. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/18544628/Bone_mineral_metabolism_and_its_relationship_to_kidney_disease_in_a_residential_care_home_population:_a_cross_sectional_study_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfn302 DB - PRIME DP - Unbound Medicine ER -