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Journal of Endocrinological Investigation

11.05.2024 | Original Article

Association of serum 25-hydroxyvitamin D with cardiovascular mortality and kidney outcome in patients with early stages of CKD

verfasst von: Y. Lin, C. Xie, Y. Zhang, F. Luo, Q. Gao, Y. Li, L. Su, R. Xu, X. Zhang, R. Chen, S. Zhou, P. Li, J. Liu, M. Liang, S. Nie, for the CRDS study Investigators

Erschienen in: Journal of Endocrinological Investigation

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Abstract

Purpose

While serum 25-hydroxyvitamin D (25[OH]D) deficiency is prevalent in chronic kidney disease (CKD), the effects of 25(OH)D deficiency on cardiovascular mortality and kidney outcomes in patients with early-stage CKD remain incompletely understood.

Methods

This multicenter retrospective cohort study included adult patients with stages 1–3 CKD from 19 medical centers across China between January 2000 and May 2021. The primary outcome was cardiovascular mortality. The secondary study outcome included CKD progression (defined as a sustained > 40% eGFR decrease from baseline or progress to end-stage kidney disease), and annual percentage change of eGFR.

Results

Of 9229 adults with stages 1–3 CKD, 27.0% and 38.9% had severe (< 10 ng/mL) and moderate (10 to < 20 ng/mL) serum 25(OH)D deficiency, respectively. Compared with patients having 25(OH)D ≥ 20 ng/mL, a significantly higher risk of cardiovascular mortality (hazard ratio [HR] 1.90, 95% CI 1.37–2.63), CKD progression (HR 2.20, 95% CI 1.68–2.88), and a steeper annual decline in eGFR (estimate − 7.87%; 95% CI − 10.24% to − 5.51% per year) was found in those with serum 25(OH)D < 10 ng/mL. Similar results were obtained in subgroups and by sensitivity analyses.

Conclusions

25(OH)D deficiency is associated with increased risks of cardiovascular mortality and CKD progression in patients with early-stage CKD. Studies are needed to determine whether early intervention for 25(OH)D deficiency could improve the prognosis of patients with early-stage CKD.

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Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M et al (2020) Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 395(10225):709–733. https://doi.org/10.1016/S0140-6736(20)30045-3CrossRef

Xie Y, Bowe B, Mokdad AH, Xian H, Yan Y, Li T et al (2018) Analysis of the global burden of disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int 94(3):567–581. https://doi.org/10.1016/j.kint.2018.04.011CrossRefPubMed

Wang L, Xu X, Zhang M, Hu C, Zhang X, Li C et al (2023) Prevalence of chronic kidney disease in china: results from the sixth china chronic disease and risk factor surveillance. JAMA Intern Med 183(4):298. https://doi.org/10.1001/jamainternmed.2022.6817CrossRefPubMedPubMedCentral

Samuel S, Sitrin MD (2008) Vitamin D’s role in cell proliferation and differentiation: nutrition reviews©, vol 66, no s2. Nutr Rev 66:S116–S124. https://doi.org/10.1111/j.1753-4887.2008.00094.xCrossRefPubMed

Lagishetty V, Liu NQ, Hewison M (2011) Vitamin D metabolism and innate immunity. Mol Cell Endocrinol 347(1–2):97–105. https://doi.org/10.1016/j.mce.2011.04.015CrossRefPubMedPubMedCentral

Zhang P, Guo D, Xu B, Huang C, Yang S, Wang W et al (2022) Association of serum 25-hydroxyvitamin D With cardiovascular outcomes and all-cause mortality in individuals with prediabetes and diabetes: results from the UK biobank prospective cohort study. Diabetes Care 45(5):1219–1229. https://doi.org/10.2337/dc21-2193CrossRefPubMed

Forman JP, Williams JS, Fisher NDL (2010) Plasma 25-hydroxyvitamin D and regulation of the renin-angiotensin system in humans. Hypertension 55(5):1283–1288. https://doi.org/10.1161/HYPERTENSIONAHA.109.148619CrossRefPubMed

Sofianopoulou E, Kaptoge SK, Afzal S, Jiang T, Gill D, Gundersen TE et al (2024) Estimating dose-response relationships for vitamin D with coronary heart disease, stroke, and all-cause mortality: observational and mendelian randomisation analyses. Lancet Diabetes Endocrinol 12(1):e2-11. https://doi.org/10.1016/S2213-8587(23)00287-5CrossRef

Agarwal R (2009) Vitamin D, proteinuria, diabetic nephropathy, and progression of CKD: Table 1. Clin J Am Soc Nephrol 4(9):1523–1528. https://doi.org/10.2215/CJN.02010309CrossRefPubMed

10.

Kramer H, Sempos C, Cao G, Luke A, Shoham D, Cooper R et al (2012) Mortality rates across 25-Hydroxyvitamin D (25OH. D) levels among adults with and without estimated glomerular filtration rate 60 ml/min/173 m2: the third national health and nutrition examination survey. PLoS ONE 7(10):e47458. https://doi.org/10.1371/journal.pone.0047458CrossRefPubMedPubMedCentral

11.

Pilz S, Tomaschitz A, Friedl C, Amrein K, Drechsler C, Ritz E et al (2011) Vitamin D status and mortality in chronic kidney disease. Nephrol Dial Transplant 26(11):3603–3609. https://doi.org/10.1093/ndt/gfr076CrossRefPubMed

12.

Giustina A, Bouillon R, Dawson-Hughes B, Ebeling PR, Lazaretti-Castro M, Lips P et al (2022) Vitamin D in the older population: a consensus statement. Endocrine. https://doi.org/10.1007/s12020-022-03208-3CrossRefPubMedPubMedCentral

13.

Vaidya A, Sun B, Forman JP, Hopkins PN, Brown NJ, Kolatkar NS et al (2011) The fok1 vitamin D receptor gene polymorphism is associated with plasma renin activity in caucasians: vitamin D receptor polymorphisms and plasma renin activity. Clin Endocrinol 74(6):783–790. https://doi.org/10.1111/j.1365-2265.2011.03991.xCrossRef

14.

Zhang Y, Kong J, Deb DK, Chang A, Li YC (2010) Vitamin D receptor attenuates renal fibrosis by suppressing the renin-angiotensin system. J Am Soc Nephrol 21(6):966–973. https://doi.org/10.1681/ASN.2009080872CrossRefPubMedPubMedCentral

15.

Ravani P, Malberti F, Tripepi G, Pecchini P, Cutrupi S, Pizzini P et al (2009) Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int 75(1):88–95. https://doi.org/10.1038/ki.2008.501CrossRefPubMed

16.

Scialla JJ, Astor BC, Isakova T, Xie H, Appel LJ, Wolf M (2013) Mineral metabolites and CKD progression in African Americans. J Am Soc Nephrol 24(1):125–135. https://doi.org/10.1681/ASN.2012070713CrossRefPubMed

17.

The CRDS investigators. Chinese Renal Disease Data System, China. http://www.crds-network.org.cn/#/database. Accessed July 29, 2022

18.

Xu X, Nie S, Xu H, Liu B, Weng J, Chen C et al (2023) Detecting neonatal AKI by serum cystatin C. J Am Soc Nephrol. https://doi.org/10.1681/ASN.0000000000000125CrossRefPubMedPubMedCentral

19.

Su G, Xiao C, Cao Y, Gao P, Xie D, Cai Q et al (2023) Piperacillin/tazobactam and risk of acute kidney injury in adults hospitalized with infection without vancomycin: a multi-centre real-world data analysis. Int J Antimicrob Agents 61(1):106691. https://doi.org/10.1016/j.ijantimicag.2022.106691CrossRefPubMed

20.

Zhou S, Su L, Xu R, Li Y, Chen R, Cao Y et al (2023) Statin initiation and risk of incident kidney disease in patients with diabetes. Can Med Assoc J 195(21):E729–E738. https://doi.org/10.1503/cmaj.230093CrossRef

21.

Su L, Li Y, Chen R, Zhang X, Cao Y, Luo F et al (2023) Epidemiology and outcomes of post-AKI proteinuria. Clin Kidney J. https://doi.org/10.1093/ckj/sfad129CrossRefPubMedPubMedCentral

22.

Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y et al (2021) New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med 385(19):1737–1749. https://doi.org/10.1056/NEJMoa2102953CrossRefPubMedPubMedCentral

23.

Liu S, Wu X, Lopez AD, Wang L, Cai Y, Page A et al (2016) An integrated national mortality surveillance system for death registration and mortality surveillance, China. Bull World Health Organ 94(1):46–57. https://doi.org/10.2471/BLT.15.153148CrossRefPubMed

24.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930. https://doi.org/10.1210/jc.2011-0385CrossRefPubMed

25.

Melamed ML, Chonchol M, Gutiérrez OM, Kalantar-Zadeh K, Kendrick J, Norris K et al (2018) The role of vitamin D in CKD stages 3 to 4: report of a scientific workshop sponsored by the National Kidney Foundation. Am J Kidney Dis 72(6):834–845. https://doi.org/10.1053/j.ajkd.2018.06.031CrossRefPubMedPubMedCentral

26.

Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281. https://doi.org/10.1056/NEJMra070553CrossRefPubMed

27.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150

28.

Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94(446):496–509. https://doi.org/10.1080/01621459.1999.10474144CrossRef

29.

Ballew SH, Zhou L, Surapaneni A, Grams ME, Windham BG, Selvin E et al (2023) A novel creatinine muscle index based on creatinine filtration: associations with frailty and mortality. J Am Soc Nephrol 34(3):495–504. https://doi.org/10.1681/ASN.0000000000000037CrossRefPubMedPubMedCentral

30.

KDIGO (2017) Clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7(1):1–59. https://doi.org/10.1016/j.kisu.2017.04.001CrossRef

31.

Zhu K, Knuiman M, Divitini M, Hung J, Lim EM, Cooke BR et al (2018) Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: a 20-year study of a community-based cohort. Clin Endocrinol 88(1):154–163. https://doi.org/10.1111/cen.13485CrossRef

32.

Amer M, Qayyum R (2013) Relationship between 25-Hydroxyvitamin D and all-cause and cardiovascular disease mortality. Am J Med 126(6):509–514. https://doi.org/10.1016/j.amjmed.2012.11.021CrossRefPubMed

33.

Reimer KC, Nadal J, Meiselbach H, Schmid M, Schultheiss UT, Kotsis F et al (2023) Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the German Chronic Kidney Disease (GCKD) cohort. Bone Res 11(1):52. https://doi.org/10.1038/s41413-023-00291-8CrossRefPubMedPubMedCentral

34.

Kendrick J, Cheung AK, Kaufman JS, Greene T, Roberts WL, Smits G et al (2012) Associations of plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations with death and progression to maintenance dialysis in patients with advanced kidney disease. Am J Kidney Dis 60(4):567–575. https://doi.org/10.1053/j.ajkd.2012.04.014CrossRefPubMedPubMedCentral

35.

Hannan M, Ansari S, Meza N, Anderson AH, Srivastava A, Waikar S et al (2021) Risk factors for CKD progression: overview of findings from the CRIC study. Clin J Am Soc Nephrol 16(4):648–659. https://doi.org/10.2215/CJN.07830520CrossRefPubMed

36.

Staples A, Wong C (2010) Risk factors for progression of chronic kidney disease. Curr Opin Pediatr 22(2):161–169. https://doi.org/10.1097/MOP.0b013e328336ebb0CrossRefPubMedPubMedCentral

37.

de Boer IH, Katz R, Chonchol M, Ix JH, Sarnak MJ, Shlipak MG et al (2011) Serum 25-hydroxyvitamin D and change in estimated glomerular filtration rate. Clin J Am Soc Nephrol 6(9):2141–2149. https://doi.org/10.2215/CJN.02640311CrossRefPubMedPubMedCentral

38.

Zhou C, He P, Ye Z, Zhang Y, Zhang Y, Yang S et al (2022) Relationships of serum 25-hydroxyvitamin D concentrations, diabetes, genetic susceptibility, and new-onset chronic kidney disease. Diabetes Care 45(11):2518–2525. https://doi.org/10.2337/dc22-1194CrossRefPubMed

39.

Verouti SN, Tsilibary EC, Fragopoulou E, Iatrou C, Demopoulos CA, Charonis AS et al (2013) Vitamin D receptor activators upregulate and rescue podocalyxin expression in high glucose-treated human podocytes. Nephron Exp Nephrol 122(1–2):36–50. https://doi.org/10.1159/000346562CrossRef

40.

Tomaschitz A, Pilz S, Ritz E, Grammer T, Drechsler C, Boehm BO et al (2010) Independent association between 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D and the renin–angiotensin system. Clin Chim Acta 411(17–18):1354–1360. https://doi.org/10.1016/j.cca.2010.05.037CrossRefPubMed

41.

Dusso A, González EA, Martin KJ (2011) Vitamin D in chronic kidney disease. Best Pract Res Clin Endocrinol Metab 25(4):647–655. https://doi.org/10.1016/j.beem.2011.05.005CrossRefPubMed

42.

Li YC, Kong J, Wei M, Chen Z-F, Liu SQ, Cao L-P (2002) 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Investig 110(2):229–238. https://doi.org/10.1172/JCI0215219CrossRefPubMedPubMedCentral

43.

Bouillon R, Carmeliet G, Verlinden L, van Etten E, Verstuyf A, Luderer HF et al (2008) Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev 29(6):726–776. https://doi.org/10.1210/er.2008-0004CrossRefPubMedPubMedCentral

44.

Wang Y, Zheng Y, Chen P, Liang S, He P, Shao X et al (2021) The weak correlation between serum vitamin levels and chronic kidney disease in hospitalized patients: a cross-sectional study. BMC Nephrol 22(1):292. https://doi.org/10.1186/s12882-021-02498-5CrossRefPubMedPubMedCentral

45.

Agarwal R, Acharya M, Tian J, Hippensteel RL, Melnick JZ, Qiu P et al (2005) Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney Int 68(6):2823–2828. https://doi.org/10.1111/j.1523-1755.2005.00755.xCrossRefPubMed

46.

Timms PM, Mannan N, Hitman GA, Noonan K, Mills PG, Syndercombe-Court D et al (2002) Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 95(12):787–796. https://doi.org/10.1093/qjmed/95.12.787CrossRefPubMed

47.

Fernández-Juárez G, Luño J, Barrio V, de Vinuesa SG, Praga M, Goicoechea M et al (2013) 25 (OH) Vitamin D levels and renal disease progression in patients with type 2 diabetic nephropathy and blockade of the renin-angiotensin system. Clin J Am Soc Nephrol 8(11):1870–1876. https://doi.org/10.2215/CJN.00910113CrossRefPubMedPubMedCentral

48.

de Boer IH, Ioannou GN, Kestenbaum B, Brunzell JD, Weiss NS (2007) 25-Hydroxyvitamin D levels and Albuminuria in the Third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis 50(1):69–77. https://doi.org/10.1053/j.ajkd.2007.04.015CrossRefPubMed

49.

Jorde R, Sneve M, Hutchinson M, Emaus N, Figenschau Y, Grimnes G (2010) Tracking of serum 25-hydroxyvitamin D levels during 14 years in a population-based study and during 12 months in an intervention study. Am J Epidemiol 171(8):903–908. https://doi.org/10.1093/aje/kwq005CrossRefPubMed

Titel: Association of serum 25-hydroxyvitamin D with cardiovascular mortality and kidney outcome in patients with early stages of CKD
verfasst von: Y. Lin
C. Xie
Y. Zhang
F. Luo
Q. Gao
Y. Li
L. Su
R. Xu
X. Zhang
R. Chen
S. Zhou
P. Li
J. Liu
M. Liang
S. Nie
for the CRDS study Investigators
Publikationsdatum: 11.05.2024
Verlag: Springer International Publishing
Erschienen in: Journal of Endocrinological Investigation
Elektronische ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-024-02383-6

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Association of serum 25-hydroxyvitamin D with cardiovascular mortality and kidney outcome in patients with early stages of CKD

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