较低的25-羟维生素D浓度与肾功能下降的风险有关。心力衰竭,和死亡率。然而,25-羟基维生素D需要转化为其活性代谢物,骨化三醇,对于大多数生物效应。骨化三醇浓度与临床事件的关系尚未得到很好的探讨。
病例队列研究。
功能良好的社区生活老年人,年龄在70至79岁的开始参与健康,衰老,和身体成分(健康ABC)研究。
使用正离子电喷雾电离-串联质谱法测量血清骨化三醇。
主要肾功能下降(估计肾小球滤过率从基线下降≥30%),心力衰竭(HF),以及10年随访期间的全因死亡率。
基线骨化三醇浓度是在479名参与者的随机亚队列中测量的,也是在10年的随访期间,在主要肾功能下降[n=397])和偶发HF(n=207)的病例中测量的。使用加权Cox回归评估血清骨化三醇浓度与这些终点的关联,以考虑病例队列设计,而仅在亚队列中使用未加权Cox回归评估与死亡率的相关性.
在8.6年的平均随访中,212(44%)亚组参与者死亡。在完全调整的模型中,骨化三醇浓度每降低1个标准差与主要肾功能下降的风险增加30%相关(95%CI,1.03~1.65;P=0.03).骨化三醇与HF事件无关(HR,1.16;95%CI,0.94-1.47)或死亡率(HR,1.01;95%CI,0.81-1.26)。我们观察到骨化三醇浓度和慢性肾病状态之间没有显著的相互作用,基线完整甲状旁腺或成纤维细胞因子23浓度。
观察性研究设计,在单个时间点测量骨化三醇,仅对白人或黑人种族的老年人进行选择性研究。
较低的骨化三醇浓度与社区生活老年人肾功能下降独立相关。未来的研究将需要澄清这些关联是否反映了由于肾小管功能异常导致的较低的骨化三醇浓度或较低的骨化三醇浓度与更快的肾功能丧失相关的直接机制。
Lower 25-hydroxyvitamin D concentrations have been associated with risk for kidney function decline, heart failure, and mortality. However, 25-hydroxyvitamin D requires conversion to its active metabolite, calcitriol, for most biological effects. The associations of calcitriol concentrations with clinical events have not been well explored.
Case-cohort study.
Well-functioning community-living older adults aged 70 to 79 years at inception who participated in the Health, Aging, and Body Composition (Health ABC) Study.
Serum calcitriol measured using positive ion electrospray ionization-tandem mass spectrometry.
Major kidney function decline (≥30% decline in estimated glomerular filtration rate from baseline), incident heart failure (HF), and all-cause mortality during 10 years of follow-up.
Baseline calcitriol concentrations were measured in a random subcohort of 479 participants and also in cases with major kidney function decline [n=397]) and incident HF (n=207) during 10 years of follow-up. Associations of serum calcitriol concentrations with these end points were evaluated using weighted Cox regression to account for the case-cohort design, while associations with mortality were assessed in the subcohort alone using unweighted Cox regression.
During 8.6 years of mean follow-up, 212 (44%) subcohort participants died. In fully adjusted models, each 1-standard deviation lower calcitriol concentration was associated with 30% higher risk for major kidney function decline (95% CI, 1.03-1.65; P=0.03). Calcitriol was not significantly associated with incident HF (HR, 1.16; 95% CI, 0.94-1.47) or mortality (HR, 1.01; 95% CI, 0.81-1.26). We observed no significant interactions between calcitriol concentrations and chronic kidney disease status, baseline intact parathyroid or fibroblast factor 23 concentrations.
Observational study design, calcitriol measurements at a single time point, selective study population of older adults only of white or black race.
Lower calcitriol concentrations are independently associated with kidney function decline in community-living older adults. Future studies will be needed to clarify whether these associations reflect lower calcitriol concentrations resulting from abnormal kidney tubule dysfunction or direct mechanisms relating lower calcitriol concentrations to more rapid loss of kidney function.