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Distinct impact of vitamin D insufficiency on calcitriol levels in chronic renal failure and renal transplant patients: a role for FGF23.
J Nephrol. 2012 Nov-Dec; 25(6):1108-18.JN

Abstract

INTRODUCTION

Vitamin D insufficiency contributes to calcitriol (1,25D) reduction in chronic kidney disease (CKD). Since CKD patients on conservative therapy (CRF) mostly develop, whereas transplant (TX) patients possibly recover from, secondary hyperparathyroidism (SH), we hypothesized a different efficiency of vitamin D hydroxylation in these 2 clinical conditions.

METHODS

We compared the impact of reduced 25-hydroxyvitamin D (25D) on circulating 1,25D in 111 CRF (mean age 63 ± 15 years; estimated glomerular filtration rate [eGFR] 36.4 ± 22.0 ml/min) and in 136 TX patients (mean age 50 ± 11 years; eGFR 47 ± 19.0 ml/min).

RESULTS

Vitamin D insufficient patients (69.1% in TX vs. 82% in CRF; p<0.005), compared with those without insufficiency, had lower values of 1,25D in CRF (24.5 ± 17.4 vs 35.8 ± 17.8 pg/mL; p<0.01) but not in TX (42.7 ± 23.8 vs. 50.1 ± 25.4 pg/mL; p=n.s.). Serum 25D and 1,25D were correlated in both CRF (r=0.387, p<0.0001) and TX (r=0.240, p0<.005) groups, but 1,25D values were higher in the TX group in any of the 4 ranges for 25D considered. Serum calcitriol correlated with eGFR (CRF: r=0.641, p<0.0001; TX: r=0.426, p<0.0001), but again with higher values in the TX group, in any of the CKD stages considered, except stage 2. In both conditions, the most predictive parameter of 1,25D levels was eGFR, together with phosphate and 25D in the CRF group (r2=0.545; p<0.0001), and with Ca and 25D in the TX group (r2=0.345; p<0.0001). In 2 subgroups, comparable for eGFR and 25D, levels of FGF23 were lower in the TX group, in agreement with higher values of 1,25D.

CONCLUSIONS

A 25D deficit more significantly affects calcitriol concentrations in CRF as compared with TX. Efficiency of vitamin D hydroxylation should be considered when planning vitamin D replacement strategies.

Authors+Show Affiliations

Department of Cardiovascular, Respiratory, Nephrological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy. sandro.mazzaferro@uniroma1.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22383345

Citation

Mazzaferro, Sandro, et al. "Distinct Impact of Vitamin D Insufficiency On Calcitriol Levels in Chronic Renal Failure and Renal Transplant Patients: a Role for FGF23." Journal of Nephrology, vol. 25, no. 6, 2012, pp. 1108-18.
Mazzaferro S, Pasquali M, Pugliese F, et al. Distinct impact of vitamin D insufficiency on calcitriol levels in chronic renal failure and renal transplant patients: a role for FGF23. J Nephrol. 2012;25(6):1108-18.
Mazzaferro, S., Pasquali, M., Pugliese, F., Citterio, F., Gargiulo, A., Rotondi, S., Tartaglione, L., Conte, C., Pirrò, G., & Taggi, F. (2012). Distinct impact of vitamin D insufficiency on calcitriol levels in chronic renal failure and renal transplant patients: a role for FGF23. Journal of Nephrology, 25(6), 1108-18. https://doi.org/10.5301/jn.5000102
Mazzaferro S, et al. Distinct Impact of Vitamin D Insufficiency On Calcitriol Levels in Chronic Renal Failure and Renal Transplant Patients: a Role for FGF23. J Nephrol. 2012 Nov-Dec;25(6):1108-18. PubMed PMID: 22383345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distinct impact of vitamin D insufficiency on calcitriol levels in chronic renal failure and renal transplant patients: a role for FGF23. AU - Mazzaferro,Sandro, AU - Pasquali,Marzia, AU - Pugliese,Francesco, AU - Citterio,Franco, AU - Gargiulo,Antonio, AU - Rotondi,Silverio, AU - Tartaglione,Lida, AU - Conte,Carmina, AU - Pirrò,Giuliana, AU - Taggi,Franco, PY - 2011/12/27/accepted PY - 2012/3/3/entrez PY - 2012/3/3/pubmed PY - 2013/5/7/medline SP - 1108 EP - 18 JF - Journal of nephrology JO - J Nephrol VL - 25 IS - 6 N2 - INTRODUCTION: Vitamin D insufficiency contributes to calcitriol (1,25D) reduction in chronic kidney disease (CKD). Since CKD patients on conservative therapy (CRF) mostly develop, whereas transplant (TX) patients possibly recover from, secondary hyperparathyroidism (SH), we hypothesized a different efficiency of vitamin D hydroxylation in these 2 clinical conditions. METHODS: We compared the impact of reduced 25-hydroxyvitamin D (25D) on circulating 1,25D in 111 CRF (mean age 63 ± 15 years; estimated glomerular filtration rate [eGFR] 36.4 ± 22.0 ml/min) and in 136 TX patients (mean age 50 ± 11 years; eGFR 47 ± 19.0 ml/min). RESULTS: Vitamin D insufficient patients (69.1% in TX vs. 82% in CRF; p<0.005), compared with those without insufficiency, had lower values of 1,25D in CRF (24.5 ± 17.4 vs 35.8 ± 17.8 pg/mL; p<0.01) but not in TX (42.7 ± 23.8 vs. 50.1 ± 25.4 pg/mL; p=n.s.). Serum 25D and 1,25D were correlated in both CRF (r=0.387, p<0.0001) and TX (r=0.240, p0<.005) groups, but 1,25D values were higher in the TX group in any of the 4 ranges for 25D considered. Serum calcitriol correlated with eGFR (CRF: r=0.641, p<0.0001; TX: r=0.426, p<0.0001), but again with higher values in the TX group, in any of the CKD stages considered, except stage 2. In both conditions, the most predictive parameter of 1,25D levels was eGFR, together with phosphate and 25D in the CRF group (r2=0.545; p<0.0001), and with Ca and 25D in the TX group (r2=0.345; p<0.0001). In 2 subgroups, comparable for eGFR and 25D, levels of FGF23 were lower in the TX group, in agreement with higher values of 1,25D. CONCLUSIONS: A 25D deficit more significantly affects calcitriol concentrations in CRF as compared with TX. Efficiency of vitamin D hydroxylation should be considered when planning vitamin D replacement strategies. SN - 1724-6059 UR - https://www.unboundmedicine.com/medline/citation/22383345/Distinct_impact_of_vitamin_D_insufficiency_on_calcitriol_levels_in_chronic_renal_failure_and_renal_transplant_patients:_a_role_for_FGF23_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=22383345.ui DB - PRIME DP - Unbound Medicine ER -