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Predictors of vitamin D status in predialysis chronic kidney disease patients: a cross-sectional analysis in a high ultraviolet climate.
J Ren Nutr. 2012 Jul; 22(4):400-8.JR

Abstract

OBJECTIVE

To determine vitamin D status in a subtropical climate among an unselected, referred predialysis chronic kidney disease (CKD) population; assess risks and correlates; and review whether higher 25-hydroxyvitamin D (25-OHD) concentration can mitigate the decrement in circulating 1,25-dihydroxyvitamin D (1,25-OHD) normally encountered with advancing CKD.

DESIGN

Prospective cross-sectional cohort study.

SETTING

Renal unit in Brisbane, Australia (27°28' S).

SUBJECTS

Five hundred ninety-three consecutive CKD patients (stage 1 to 5).

MAIN OUTCOME MEASURE

25-OHD insufficiency (concentrations: 15 to 30 ng/mL) and deficiency (<15 ng/mL), bone-mineral parameters, including 1,25-OHD, calcium, and phosphate.

RESULTS

Despite potentially higher environmental ultraviolet (UV) exposure, only 48% of patients with CKD were 25-OHD sufficient. Traditional risks for hypovitaminosis D were maintained, and sufficiency was independently predicted by testing in the summer/autumn period (odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.88 to 4.08, P < .001), male gender (OR: 2.18, 95%CI: 1.46 to 3.24, P < .001), Caucasian race (OR: 2.28, 95%CI: 1.37 to 3.78, P = .001), hypoalbuminemia (OR: 0.47, 95%CI: 0.25 to 0.85, P = .01), macroalbuminuria (OR: 0.60, 95%CI: 0.39 to 0.92, P = .02), and normal body mass index (OR: 1.94, 95%CI: 1.22 to 3.07, P = .005). Vitamin D sufficiency was also associated with higher corrected calcium (0.4 mg/dL increments; OR: 1.29, 95%CI: 1.08 to 1.55, P = .005). Although circulating 25-OHD concentrations were relatively maintained across the range of renal function observed, 1,25-OHD concentrations decreased with advancing CKD.

CONCLUSION

25-OHD insufficiency is mitigated but still highly prevalent in patients with CKD in a high ambient UV environment. Despite the maintenance of relatively higher 25-OHD concentrations with advancing CKD, substrate availability does not appear to be a major determinant of circulating 1,25-OHD.

Authors+Show Affiliations

Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia. william_petchey@health.qld.gov.auNo 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

22074789

Citation

Petchey, William G., et al. "Predictors of Vitamin D Status in Predialysis Chronic Kidney Disease Patients: a Cross-sectional Analysis in a High Ultraviolet Climate." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 22, no. 4, 2012, pp. 400-8.
Petchey WG, Johnson DW, Hawley CM, et al. Predictors of vitamin D status in predialysis chronic kidney disease patients: a cross-sectional analysis in a high ultraviolet climate. J Ren Nutr. 2012;22(4):400-8.
Petchey, W. G., Johnson, D. W., Hawley, C. M., & Isbel, N. M. (2012). Predictors of vitamin D status in predialysis chronic kidney disease patients: a cross-sectional analysis in a high ultraviolet climate. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 22(4), 400-8. https://doi.org/10.1053/j.jrn.2011.08.007
Petchey WG, et al. Predictors of Vitamin D Status in Predialysis Chronic Kidney Disease Patients: a Cross-sectional Analysis in a High Ultraviolet Climate. J Ren Nutr. 2012;22(4):400-8. PubMed PMID: 22074789.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of vitamin D status in predialysis chronic kidney disease patients: a cross-sectional analysis in a high ultraviolet climate. AU - Petchey,William G, AU - Johnson,David W, AU - Hawley,Carmel M, AU - Isbel,Nicole M, Y1 - 2011/11/09/ PY - 2011/05/18/received PY - 2011/08/17/revised PY - 2011/08/24/accepted PY - 2011/11/15/entrez PY - 2011/11/15/pubmed PY - 2012/12/10/medline SP - 400 EP - 8 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 22 IS - 4 N2 - OBJECTIVE: To determine vitamin D status in a subtropical climate among an unselected, referred predialysis chronic kidney disease (CKD) population; assess risks and correlates; and review whether higher 25-hydroxyvitamin D (25-OHD) concentration can mitigate the decrement in circulating 1,25-dihydroxyvitamin D (1,25-OHD) normally encountered with advancing CKD. DESIGN: Prospective cross-sectional cohort study. SETTING: Renal unit in Brisbane, Australia (27°28' S). SUBJECTS: Five hundred ninety-three consecutive CKD patients (stage 1 to 5). MAIN OUTCOME MEASURE: 25-OHD insufficiency (concentrations: 15 to 30 ng/mL) and deficiency (<15 ng/mL), bone-mineral parameters, including 1,25-OHD, calcium, and phosphate. RESULTS: Despite potentially higher environmental ultraviolet (UV) exposure, only 48% of patients with CKD were 25-OHD sufficient. Traditional risks for hypovitaminosis D were maintained, and sufficiency was independently predicted by testing in the summer/autumn period (odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.88 to 4.08, P < .001), male gender (OR: 2.18, 95%CI: 1.46 to 3.24, P < .001), Caucasian race (OR: 2.28, 95%CI: 1.37 to 3.78, P = .001), hypoalbuminemia (OR: 0.47, 95%CI: 0.25 to 0.85, P = .01), macroalbuminuria (OR: 0.60, 95%CI: 0.39 to 0.92, P = .02), and normal body mass index (OR: 1.94, 95%CI: 1.22 to 3.07, P = .005). Vitamin D sufficiency was also associated with higher corrected calcium (0.4 mg/dL increments; OR: 1.29, 95%CI: 1.08 to 1.55, P = .005). Although circulating 25-OHD concentrations were relatively maintained across the range of renal function observed, 1,25-OHD concentrations decreased with advancing CKD. CONCLUSION: 25-OHD insufficiency is mitigated but still highly prevalent in patients with CKD in a high ambient UV environment. Despite the maintenance of relatively higher 25-OHD concentrations with advancing CKD, substrate availability does not appear to be a major determinant of circulating 1,25-OHD. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/22074789/Predictors_of_vitamin_D_status_in_predialysis_chronic_kidney_disease_patients:_a_cross_sectional_analysis_in_a_high_ultraviolet_climate_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(11)00153-1 DB - PRIME DP - Unbound Medicine ER -