Clin Endocrinol (Oxf). 2013 Feb 18. doi: 10.1111/cen.12172.
Leaf DE, Waikar SS, Wolf M, Cremers S, Bhan I, Stern L.
Division of Nephrology, Columbia University Medical Center, New York, NY; Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA.
OBJECTIVE: Numerous studies have evaluated the prevalence and importance of vitamin D deficiency among patients with chronic kidney disease and end-stage renal disease, however, little is known about vitamin D levels in acute kidney injury (AKI). We evaluated the association between vitamin D metabolites and clinical outcomes among patients with AKI.
DESIGN: Prospective cohort study.
PATIENTS: 30 participants with AKI and 30 controls from general hospital wards and intensive care units at a tertiary care hospital.
MEASUREMENTS: Plasma levels of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2) D], 24R,25-dihydroxyvitamin D(3) , vitamin D binding protein (VDBP), and fibroblast growth factor 23 (FGF23) were measured within 24 hours of AKI onset and 5 days later. Bioavailable 25(OH)D and 1,25(OH)(2) D levels, defined as the sum of free- and albumin-bound 25(OH)D and 1,25(OH)(2) D, were estimated using equations.
RESULTS: Compared to controls, participants with AKI had lower levels of 1,25(OH)(2) D [17 (10-22) versus 25 (15-35) pg/ml, p=0.01], lower levels of VDBP [23 (15-31) versus 29 (25-36) mg/dl, p=0.003], and similar levels of bioavailable 25(OH)D and 1,25(OH)(2) D at enrollment. Levels of bioavailable 25(OH)D were inversely associated with severity of sepsis in the overall sample (p<0.001). Among participants with AKI, bioavailable 25(OH)D, but not other vitamin D metabolites, was significantly associated with mortality after adjusting for age and serum creatinine (adjusted odds ratio per 1 SD ln [bioavailable 25(OH)D] = 0.16, 95% confidence interval=0.03 to 0.85).
CONCLUSIONS: Bioavailable 25(OH)D could have a role as a biomarker or mediator of adverse outcomes among patients with established AKI. © 2013 Blackwell Publishing Ltd.
© 2013 Blackwell Publishing Ltd.
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