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Serum 25-hydroxyvitamin D deficiency and the 5-year incidence of CKD.
Am J Kidney Dis. 2013 Jul; 62(1):58-66.AJ

Abstract

BACKGROUND

Low serum 25-hydroxyvitamin D (25[OH]D) levels have been associated with chronic kidney disease in cross-sectional studies. However, this association has not been studied prospectively in a large general population-based cohort.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

6,180 adults 25 years or older participating in the baseline and 5-year follow-up phases of the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study.

PREDICTOR

Serum 25(OH)D levels <15 ng/mL were considered deficient.

OUTCOMES & MEASUREMENTS

Incident chronic kidney disease was defined as being negative at baseline but positive after 5 years for (1) reduced estimated glomerular filtration rate (eGFR; <60 mL/min/1.72 m²) or (2) albuminuria (spot urine albumin-creatinine ratio ≥2.5 mg/mmol [≥22.1 mg/g] for men and ≥3.5 mg/mmol [≥30.9 mg/g] for women).

RESULTS

623 (10.9%) participants were vitamin D deficient, 161 developed incident reduced eGFR, and 222 developed incident albuminuria. In participants with and without vitamin D deficiency, annual age-standardized incidences were 0.92% (95% CI, 0.56%-1.30%) and 0.59% (95% CI, 0.51%-0.68%), respectively, for eGFR <60 mL/min/1.72 m² and 1.50% (95% CI, 1.06%-1.95%) and 0.66% (95% CI, 0.56%-0.76%), respectively, for albuminuria. In multivariate regression models, vitamin D deficiency was associated significantly with the 5-year incidence of albuminuria (OR, 1.71; 95% CI, 1.12-2.61; P = 0.01), but not reduced eGFR (OR, 0.93; 95% CI, 0.53-1.66; P = 0.8).

LIMITATIONS

The observational nature of the study does not account for unmeasured confounders. Only baseline 25(OH)D level was measured and therefore may not accurately reflect lifetime levels. Differences in baseline characteristics of participants who were included compared with those excluded due to missing data or follow-up may limit the applicability of results to the original AusDiab cohort.

CONCLUSIONS

Our prospective cohort study shows that vitamin D deficiency is associated with a higher annual incidence of albuminuria and reduced eGFR and independently predicts the 5-year incidence of albuminuria. These associations warrant further exploration in long-term prospective clinical trials.

Authors+Show Affiliations

Department of Nephrology, Monash Medical Centre, Melbourne, Australia. matthew.damasiewicz@monash.eduNo 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

23623574

Citation

Damasiewicz, Matthew J., et al. "Serum 25-hydroxyvitamin D Deficiency and the 5-year Incidence of CKD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 62, no. 1, 2013, pp. 58-66.
Damasiewicz MJ, Magliano DJ, Daly RM, et al. Serum 25-hydroxyvitamin D deficiency and the 5-year incidence of CKD. Am J Kidney Dis. 2013;62(1):58-66.
Damasiewicz, M. J., Magliano, D. J., Daly, R. M., Gagnon, C., Lu, Z. X., Sikaris, K. A., Ebeling, P. R., Chadban, S. J., Atkins, R. C., Kerr, P. G., Shaw, J. E., & Polkinghorne, K. R. (2013). Serum 25-hydroxyvitamin D deficiency and the 5-year incidence of CKD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 62(1), 58-66. https://doi.org/10.1053/j.ajkd.2013.03.010
Damasiewicz MJ, et al. Serum 25-hydroxyvitamin D Deficiency and the 5-year Incidence of CKD. Am J Kidney Dis. 2013;62(1):58-66. PubMed PMID: 23623574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum 25-hydroxyvitamin D deficiency and the 5-year incidence of CKD. AU - Damasiewicz,Matthew J, AU - Magliano,Dianna J, AU - Daly,Robin M, AU - Gagnon,Claudia, AU - Lu,Zhong X, AU - Sikaris,Ken A, AU - Ebeling,Peter R, AU - Chadban,Steven J, AU - Atkins,Robert C, AU - Kerr,Peter G, AU - Shaw,Jonathan E, AU - Polkinghorne,Kevan R, Y1 - 2013/04/23/ PY - 2012/07/16/received PY - 2013/03/06/accepted PY - 2013/4/30/entrez PY - 2013/4/30/pubmed PY - 2013/8/21/medline SP - 58 EP - 66 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 62 IS - 1 N2 - BACKGROUND: Low serum 25-hydroxyvitamin D (25[OH]D) levels have been associated with chronic kidney disease in cross-sectional studies. However, this association has not been studied prospectively in a large general population-based cohort. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 6,180 adults 25 years or older participating in the baseline and 5-year follow-up phases of the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. PREDICTOR: Serum 25(OH)D levels <15 ng/mL were considered deficient. OUTCOMES & MEASUREMENTS: Incident chronic kidney disease was defined as being negative at baseline but positive after 5 years for (1) reduced estimated glomerular filtration rate (eGFR; <60 mL/min/1.72 m²) or (2) albuminuria (spot urine albumin-creatinine ratio ≥2.5 mg/mmol [≥22.1 mg/g] for men and ≥3.5 mg/mmol [≥30.9 mg/g] for women). RESULTS: 623 (10.9%) participants were vitamin D deficient, 161 developed incident reduced eGFR, and 222 developed incident albuminuria. In participants with and without vitamin D deficiency, annual age-standardized incidences were 0.92% (95% CI, 0.56%-1.30%) and 0.59% (95% CI, 0.51%-0.68%), respectively, for eGFR <60 mL/min/1.72 m² and 1.50% (95% CI, 1.06%-1.95%) and 0.66% (95% CI, 0.56%-0.76%), respectively, for albuminuria. In multivariate regression models, vitamin D deficiency was associated significantly with the 5-year incidence of albuminuria (OR, 1.71; 95% CI, 1.12-2.61; P = 0.01), but not reduced eGFR (OR, 0.93; 95% CI, 0.53-1.66; P = 0.8). LIMITATIONS: The observational nature of the study does not account for unmeasured confounders. Only baseline 25(OH)D level was measured and therefore may not accurately reflect lifetime levels. Differences in baseline characteristics of participants who were included compared with those excluded due to missing data or follow-up may limit the applicability of results to the original AusDiab cohort. CONCLUSIONS: Our prospective cohort study shows that vitamin D deficiency is associated with a higher annual incidence of albuminuria and reduced eGFR and independently predicts the 5-year incidence of albuminuria. These associations warrant further exploration in long-term prospective clinical trials. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/23623574/Serum_25_hydroxyvitamin_D_deficiency_and_the_5_year_incidence_of_CKD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(13)00666-5 DB - PRIME DP - Unbound Medicine ER -