Effect of serum vitamin D level on renal function in elderly patients with chronic kidney disease

Abstract

Abstract:

ObjectiveTo investigate the association between vitamin D and chronic kidney disease (CKD) in elderly patients.MethodsThe clinical and follow-up data of elderly patients aged≥60 years diagnosed with CKD at stage 1-4 were collected in the Department of Nephrology and Department of Geriatrics of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2014 to May 2019. The serum 25-hydroxy vitamin D[25(OH)D] level was detected using photochemical method. All patients were divided into vitamin D deficiency group [25(OH)D<50 nmol/L] and non-deficiency group [including sufficient and insufficient levels of 25(OH)D, namely 25(OH)D≥50 nmol/L] according to 25(OH)D level. The baseline clinical and prognostic indicators were compared between two groups.ResultsTotally 347 elderly CKD patients were enrolled in this study. Compared to the patients with stage 1-2 CKD, the vitamin D level in those with stage 3-4 CKD was significantly lower. The incidence of vitamin D deficiency in the patients with stage 1-2 CKD and stage 3-4 CKD was 46.7% and 67.6%, respectively. Compared with the patients without vitamin D deficiency at stage 3-4 CKD, the patients with vitamin D deficiency at same stage had higher parathyroid hormone, serum uric acid, serum creatinine and rate of estimated glomerular filtration rate(eGFR) decline of at least 30% or progression into end-stage renal disease (16.9%vs2.9%,P=0.042), and lower serum calcium and eGFR. The multivariate Logistic regression analysis showed that the vitamin D deficiency was an independent risk factor for the patients with stage 3-4 CKD after adjusting gender, age, mean arterial pressure, hemoglobin, albumin, proteinuria, and uric acid.ConclusionsThe patients with vitamin D deficiency at stages 3-4 CKD had significantly lower eGFR. The vitamin D deficiency is an independent risk factor for onset of CKD at stages 3-4.

Key words:Elderly chronic kidney disease patients,Vitamin D deficiency,Renal renal insufficiency

CLC Number:

R692

ZHANG Xiaoyan, XU Jing, QU Bin. Effect of serum vitamin D level on renal function in elderly patients with chronic kidney disease[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(04): 307-312.

Figures/Tables4

项目	CKD 1~2期（n=242）	CKD 3期及以上（n=105）	P
男/女（n）	116/126	58/47	0.211
年龄（岁）	76.0（70.0~83.0）	78.0（71.0~84.0）	0.265
收缩压（mmHg）	134.0（120.0~148.0）	133.0（120.0~149.0）	0.737
舒张压（mmHg）	70.0（65.0~80.0）	70.0（64.5~80.0）	0.707
白细胞（×10⁹/L）	6.0（5.0~7.1）	6.8（5.0~8.2）	0.026
血红蛋白（g/L）	130.7±18.2	119.1±17.5	0.639
白蛋白（g/L）	37.0（34.0~40.0）	35.0（32.0~38.5）	<0.001
25(OH)D（nmol/L）	52.6（37.4~70.8）	42.5（34.5~53.6）	<0.001
血钙（mmol/L）	2.2±0.1	2.2±0.2	0.123
血磷（mmol/L）	1.0±0.2	1.0±0.1	0.295
甲状旁腺素（ng/L）	50.5（38.7~61.5）	52.9（35.6~69.1）	0.813
尿蛋白量（g/24 h）	0.3（0.2~0.8)	0.9（0.4~1.9）	<0.001
血尿酸（μmol/L）	307.5.0（262.8~365.3）	380.0（331.5~457.5）	<0.001
血肌酐（μmol/L）	73.5（65.0~81.0）	113.0（101.5~140.0）	<0.001
eGFR[mL/（min·1.73 m²）]	79.2（68.9~87.3）	45.7（35.2~53.2）	<0.001
甘油三酯（mmol/L）	1.5±0.9	1.7±1.0	0.106
胆固醇（mmol/L）	4.6±1.4	5.0±1.4	0.165
糖化血红蛋白（%）	5.9（5.6~6.4）	6.4（5.8~7.3）	0.786
发生终点事件[n（%）]	17（7.0）	13（12.4）	0.103

项目	CKD 1~2期（n=242）			CKD 3期及以上（n=105）
项目	维生素D缺乏组（n=113）	维生素D不缺乏组（n=129）	P	维生素D缺乏组（n=71）	维生素D不缺乏组（n=34）	P
男/女（n）	58/71	58/55	0.323	40/31	18/16	0.743
年龄（岁）	77.0（72.0~84.0）	75.0（68.0~82.5）	0.119	76.0（70.0~84.0）	80.0（73.0~85.0）	0.361
收缩压（mmHg）	138.0（123.0~151.5）	130.0（119.0~143.0）	0.030	134.0（120.0~149.0）	131.5（120.0~149.3）	0.997
舒张压（mmHg）	72.0（65.5~80.0）	70.0（65.0~79.5）	0.350	70.0（64.0~80.0）	72.0（64.8~80.0）	0.771
白细胞（×10⁹/L）	5.8（4.7~7.0）	6.2（5.4~7.5）	0.020	6.6（5.0~8.2）	7.0（5.2~8.6）	0.488
血红蛋白（g/L）	133.6±19.4	128.2±16.7	0.021	118.6±17.2	120.2±18.3	0.672
白蛋白（g/L）	38.0（35.0~42.0）	37.0（33.0~40.0）	0.013	35.0（32.0~37.0）	34.5（32.8~40）	0.527
血钙（mmol/L）	2.19±0.12	2.23±0.12	0.009	2.16±0.12	2.29±0.23	0.030
血磷（mmol/L）	1.04±0.16	1.08±0.17	0.162	1.02±0.09	1.05±0.18	0.383
甲状旁腺素（ng/L）	55.5（42.0~67.2）	44.2（35.7~58.7）	0.014	62.2（52.8~74.0）	38.9（30.2~51.9）	0.002
尿蛋白量（g/24 h）	0.30（0.19~0.78）	0.35（0.20~0.84）	0.745	0.90（0.39~2.07）	0.86（0.40~1.57）	0.937
血尿酸（μmol/L）	306.0（265.0~358.0）	310.0（257.0~368.0）	0.961	390.0（336.0~473.0）	370.0（323.5~385.5）	0.026
血肌酐（μmol/L）	74.0（65.0~83.0）	73.0（65.5~80.0）	0.244	115.0（104.0~152.0）	106.0（87.5~116.3）	0.001
eGFR[mL/（min·1.73 m²）]	79.2（72.3~83.4）	76.3（66.9~86.8）	0.170	42.1（30.1~50.3）	50.8（44.5~55.2）	<0.001
甘油三酯（mmol/L）	1.4±0.7	1.5±1.1	0.150	1.8±1.2	1.5±0.9	0.177
总胆固醇（mmol/L）	4.4±1.3	4.7±1.4	0.178	5.0±1.2	4.8±1.7	0.439
糖化血红蛋白（%）	5.9（5.6~6.4）	5.9（5.6~6.2）	0.390	5.9（5.4~6.2）	5.9（5.7~6.5）	0.148
发生终点事件[n（%）]	8（7.1）	9（7.0）	0.975	12（16.9）	1（2.9）	0.042

变量	单因素		多因素
男性	1.340（0.846~2.124）	0.212	1.458（0.745~2.855）	0.271
年龄	1.016（0.990~1.044）	0.230	1.033（0.994~1.073）	0.097
平均动脉压	1.005（0.987~1.023）	0.609	1.023（0.996~1.050）	0.096
血红蛋白	0.965（0.952~0.978）	<0.001	0.958（0.939~0.977）	<0.001
白蛋白	0.942（0.906~0.980）	0.003	0.991（0.931~1.054）	0.775
尿蛋白量	1.857（1.435~2.405）	<0.001	1.667（1.185~2.345）	0.003
尿酸	1.012（1.009~1.016）	<0.001	1.013（1.008~1.018）	<0.001
维生素D缺乏	2.384（1.474~3.854）	<0.001	2.559（1.326~4.937）	0.005

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