J Nephrol. 2011 Jun 16. pii: 5403F0E0-161B-4C4F-96F9-2A4FAF4EB467. doi: 10.5301/JN.2011.8429.
Levin A, Le Barbier M, Er L, Andress D, Sigrist MK, Djurdjev O.
BC Provincial Renal Agency, Vancouver, British Columbia - Canada and Division of Nephrology, University of British Columbia, Vancouver, British Columbia - Canada.
Introduction: Vitamin D deficiencies are well described in general populations and in those with chronic kidney disease (CKD). Although serum 25(OH)D may be a good indicator of vitamin D status in healthy individuals, the hydroxylated product, 1,25(OH)2D, essential for important biological functions such as mineral metabolism, bone turnover, regulation of protein synthesis, cell differentiation and proliferation may be a more suitable indicator for individuals with CKD.
Methods: We report an observational prospective cohort study of the incidence after 12 months of new isolated 1,25(OH)2D and new 25(OH)D deficiency in CKD patients (estimated glomerular filtration rate eGFR <60 ml/min), who were vitamin D replete at baseline. All analyses were run in a central laboratory.
Results: Of 1,256 patients who completed the study at 12 months, 631 were replete in both 25(OH)D and 1,25(OH)2D at baseline;
- at 12 months, 65% remained replete,
- 25% developed an isolated 1,25(OH)2D deficiency, whereas
- only 6% developed an isolated 25(OH)D deficiency.
Based on the multinomial logistic regression model, factors that were associated with 12-month changes in vitamin D status were diabetes, baseline values of eGFR, albumin and both 25(OH)D and 1,25(OH)2D (all p values <0.03). Patients with diabetes, lower albumin, lower eGFR, lower levels of 25(OH)D and 1,25(OH)2D at baseline were at increased risk of developing isolated 1,25(OH)2D deficiency.
Conclusions: The high incidence of new isolated 1,25(OH)2D deficiency as compared with new 25(OH)D deficiency, in the presence of 25(OH)D sufficiency, brings into question the value of measuring 25(OH)D levels in CKD. The significance of these findings and implications for replacement strategies require further study.
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Starting with CKD patients who were vitamin D replete (20ng or 30ng ?), 1 year later 4X more had become deficient in 1,25(OH)2D than in 25(OH)D
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