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Current recommended 25-hydroxyvitamin D targets for chronic kidney disease management may be too low.
J Nephrol. 2016 Feb; 29(1):63-70.JN

Abstract

OBJECTIVE

It is uncertain whether increasing 25-hydroxyvitamin D (25-D) levels in chronic kidney disease (CKD) patients above those recommended by current guidelines result in progressive amelioration of secondary hyperparathyroidism. Our objective was to identify a potential therapeutic 25-D target which optimally lowers plasma parathyroid hormone (PTH) without producing excessive hypercalcemia or hyperphosphatemia in CKD.

METHODS

We performed a cross-sectional analysis of 14,289 unselected stage 1-5 CKD patients from US primary care and nephrology practices utilizing a laboratory-based CKD clinical decision support service between September 2008 and May 2012. Estimated glomerular filtration rate (eGFR), plasma PTH, and serum 25-D, calcium, and phosphorus results were analyzed.

RESULTS

In CKD stages 3-5, progressively higher 25-D pentiles contained progressively lower mean PTH levels. Regression analysis of log PTH on 25-D was significant in all CKD stages with no evidence of a decreasing effect of 25-D to lower PTH until 25-D levels of 42-48 ng/ml. Progressively higher 25-D concentrations were not associated with increased rates of hypercalcemia or hyperphosphatemia.

CONCLUSIONS

We found evidence for an optimal level of 25-D above which suppression of PTH progressively diminishes. This level is more than twice that currently recommended for the general population. We found no association between these higher 25-D levels and hyperphosphatemia or hypercalcemia. Additional prospective trials seem appropriate to test the idea that 25-D levels around 40-50 ng/ml could be a safe and effective treatment target for secondary hyperparathyroidism in CKD.

Authors+Show Affiliations

Litholink® Corporation, 2250 W. Campbell Park Drive, Chicago, IL, 60612, USA. ennisj1@labcorp.com.Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA.Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA.Division of Nephrology and Hypertension, NorthShore University HealthSystem, Evanston, IL, USA.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

25736620

Citation

Ennis, Jennifer L., et al. "Current Recommended 25-hydroxyvitamin D Targets for Chronic Kidney Disease Management May Be Too Low." Journal of Nephrology, vol. 29, no. 1, 2016, pp. 63-70.
Ennis JL, Worcester EM, Coe FL, et al. Current recommended 25-hydroxyvitamin D targets for chronic kidney disease management may be too low. J Nephrol. 2016;29(1):63-70.
Ennis, J. L., Worcester, E. M., Coe, F. L., & Sprague, S. M. (2016). Current recommended 25-hydroxyvitamin D targets for chronic kidney disease management may be too low. Journal of Nephrology, 29(1), 63-70. https://doi.org/10.1007/s40620-015-0186-0
Ennis JL, et al. Current Recommended 25-hydroxyvitamin D Targets for Chronic Kidney Disease Management May Be Too Low. J Nephrol. 2016;29(1):63-70. PubMed PMID: 25736620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current recommended 25-hydroxyvitamin D targets for chronic kidney disease management may be too low. AU - Ennis,Jennifer L, AU - Worcester,Elaine M, AU - Coe,Fredric L, AU - Sprague,Stuart M, Y1 - 2015/03/04/ PY - 2014/12/22/received PY - 2015/02/24/accepted PY - 2015/3/5/entrez PY - 2015/3/5/pubmed PY - 2016/10/25/medline KW - 25-Hydroxyvitamin D KW - Calcium KW - Chronic kidney disease KW - Parathyroid hormone KW - Phosphorus SP - 63 EP - 70 JF - Journal of nephrology JO - J Nephrol VL - 29 IS - 1 N2 - OBJECTIVE: It is uncertain whether increasing 25-hydroxyvitamin D (25-D) levels in chronic kidney disease (CKD) patients above those recommended by current guidelines result in progressive amelioration of secondary hyperparathyroidism. Our objective was to identify a potential therapeutic 25-D target which optimally lowers plasma parathyroid hormone (PTH) without producing excessive hypercalcemia or hyperphosphatemia in CKD. METHODS: We performed a cross-sectional analysis of 14,289 unselected stage 1-5 CKD patients from US primary care and nephrology practices utilizing a laboratory-based CKD clinical decision support service between September 2008 and May 2012. Estimated glomerular filtration rate (eGFR), plasma PTH, and serum 25-D, calcium, and phosphorus results were analyzed. RESULTS: In CKD stages 3-5, progressively higher 25-D pentiles contained progressively lower mean PTH levels. Regression analysis of log PTH on 25-D was significant in all CKD stages with no evidence of a decreasing effect of 25-D to lower PTH until 25-D levels of 42-48 ng/ml. Progressively higher 25-D concentrations were not associated with increased rates of hypercalcemia or hyperphosphatemia. CONCLUSIONS: We found evidence for an optimal level of 25-D above which suppression of PTH progressively diminishes. This level is more than twice that currently recommended for the general population. We found no association between these higher 25-D levels and hyperphosphatemia or hypercalcemia. Additional prospective trials seem appropriate to test the idea that 25-D levels around 40-50 ng/ml could be a safe and effective treatment target for secondary hyperparathyroidism in CKD. SN - 1724-6059 UR - https://www.unboundmedicine.com/medline/citation/25736620/Current_recommended_25_hydroxyvitamin_D_targets_for_chronic_kidney_disease_management_may_be_too_low_ L2 - https://dx.doi.org/10.1007/s40620-015-0186-0 DB - PRIME DP - Unbound Medicine ER -