Original ResearchVitamin D Deficiency, Inflammation, and Albuminuria in Chronic Kidney Disease: Complex Interactions
Section snippets
Study Population
The design of Study of Early Evaluation of Kidney Disease has been described in detail previously.18 Study of Early Evaluation of Kidney Disease is a multicenter, community-based, observational cohort study that aimed to evaluate the prevalence of abnormalities in levels of parathyroid hormone (PTH), 25D, 1,25D, calcium, and phosphorus in patients with CKD. More than 70% of subjects were recruited from primary care practices that were equally distributed throughout the United States. Subjects
Description of the Cohort
Characteristics of patients with albuminuria, as defined by UACR >30 mg/g (n = 1,190), compared with UACR ≤30 mg/g (n = 657) are shown in Table 1. Notably, compared with the nonalbuminuric group, patients with albuminuria were more likely to have diabetes, lower eGFR, and decreased 25D and 1,25D levels.
Relationship Between Vitamin D Levels and the Prevalence of Albuminuria
The lowest 25D tertile compared with the highest 25D tertile was associated with the presence of albuminuria in univariate and in all but the 2 final adjusted analyses, the models that included
Discussion
In this cross-sectional study, lower levels of 25D and 1,25D were associated with albuminuria in patients with CKD, with the lowest tertiles of 25D and 1,25D each associated with 2 to 3 times increased odds of albuminuria compared with the highest tertiles. This association for both 25D and 1,25D was independent of age, gender, race, SBP, and diabetes. In the case of 25D, the trend for the observed linear relationship between albuminuria and 25D tertiles persisted with additional adjustment for
References (26)
Renoprotective effects of vitamin D analogs
Kidney Int
(2010)- et al.
Calcium-independent and 1,25(OH)2D3-dependent regulation of the renin-angiotensin system in 1alpha-hydroxylase knockout mice
Kidney Int
(2008) - et al.
Vascular calcification and inorganic phosphate
Am J Kidney Dis
(2001) - et al.
C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease
Kidney Int
(2005) - et al.
Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease
Kidney Int
(2007) - et al.
25-Hydroxyvitamin D levels and albuminuria in the Third National Health and Nutrition Examination Survey (NHANES III)
Am J Kidney Dis
(2007) - et al.
Antiproteinuric effect of oral paricalcitol in chronic kidney disease
Kidney Int
(2005) - et al.
Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease
Kidney Int
(2004) - et al.
Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure
Kidney Int
(1999) - et al.
Vitamin D levels and early mortality among incident hemodialysis patients
Kidney Int
(2007)
Vitamin D, proteinuria, diabetic nephropathy, and progression of CKD
Clin J Am Soc Nephrol
1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system
J Clin Invest
Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin-angiotensin systems
Am J Physiol Endocrinol Metab
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Plasma 25-Hydroxyvitamin D3 Concentrations and Risk of New-Onset Proteinuria in Patients With Hypertension
2021, Journal of Renal NutritionVitamin D in kidney disease
2021, Nutritional Management of Renal Disease, Fourth EditionCalcitriol Reduces Albuminuria and Urinary Angiotensinogen Level in Renal Transplant Recipients
2018, Transplantation ProceedingsCitation Excerpt :UACR and UAGT levels were significantly higher in the low 25-(OH)D group than in the normal 25-(OH)D group, and 25-(OH)D levels were negatively correlated with these parameters. An inverse relationship was shown between 25-(OH)D level and degree of albuminuria [8,9,30]. It has been suggested that this association may be related to direct cellular effects of vitamin D deficiency, such as overexpression of renin transcription, inflammation, and fibrosis associated with podocyte loss and increasing glomerulosclerosis [31–33].
Addition of vitamin D reverses the decline in GFR following treatment with ACE inhibitors/angiotensin receptor blockers in patients with chronic kidney disease
2017, Life SciencesCitation Excerpt :Indeed, almost all patients with PD suffer from vit D deficiency [27]. Low vit D levels in individuals with CKD are associated with higher blood pressure [25,28], higher proteinuria [29,30] and more frequent need for dialysis [21,34]. In CKD patients, treatment with vit D decreases proteinuria (21,34-37), cardiovascular events [35] and all-cause mortality in CKD patients, without an increase in side effects [36].