- Publikační typ
- abstrakt z konference MeSH
Vitamin D status and the relationship between serum 25(OH) vitamin D concentrations and the components of insulin resistance were examined in 120 patients with chronic kidney disease stage 2 and 3. Insulin sensitivity/resistance was calculated by the quantitative insulin sensitivity check index (QUICKI). In this analysis, the prevalence of insulin resistance was 42 %. Only 17 % of patients had serum 25(OH) vitamin D concentration in the recommended range (>/=30 ng/ml), 42 % suffered from vitamin D insufficiency and 41 % had moderate vitamin D deficiency. Insulin resistance significantly correlated with serum 25(OH)D and 1,25(OH)(2)D concentrations, renal function and protein excretion rate. Our results support the increasing evidence that vitamin D deficiency may be one of the factors participating in the development of insulin resistance already in the early stages of chronic kidney disease.
- MeSH
- chronická renální insuficience komplikace metabolismus MeSH
- dospělí MeSH
- financování organizované MeSH
- index tělesné hmotnosti MeSH
- inzulinová rezistence fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nedostatek vitaminu D epidemiologie komplikace krev MeSH
- senioři MeSH
- vitamin D krev MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Data on the efficacy and safety of long-term vitamin D supplementation in chronic kidney disease (CKD) are scarce. We assessed the effects of the 12-month vitamin D(3) treatment on mineral metabolism and calciotropic hormones in patients with CKD stages 2-4. METHODS: Eighty-seven patients (mean age 66 years, men/women 33/54) were randomized to cholecalciferol treatment with either 5,000 or 20,000 IU/week. Serum calcium, phosphate, 25(OH)D(3), 1,25(OH)(2)D(3), PTH and urinary mineral concentrations were obtained at baseline and after 4, 8 and 12 months. RESULTS: The median serum mineral concentrations were normal and not changed throughout the study. The number of hypercalciuric patients slightly increased with higher dose, but no sustained rise in calciuria was present. Vitamin D insufficiency/deficiency was revealed in 72 (83%) patients at baseline and 37 (43%) at month 12. The 25(OH)D(3) levels increased more with higher dose; a rise in 1,25(OH)(2)D(3) was less impressive. The parathyroid hormone (PTH) concentrations were reduced, but the number of subjects with PTH below the lower limit for CKD stage 3 increased equally with both doses. CONCLUSIONS: Vitamin D insufficiency/deficiency in CKD significantly improved after the 12-month cholecalciferol treatment, with higher dose being more effective and equally safe. Further studies of vitamin D(3) effects on bone metabolism are warranted. Copyright 2008 S. Karger AG, Basel.
- MeSH
- cholekalciferol aplikace a dávkování farmakologie MeSH
- chronická nemoc MeSH
- hormony MeSH
- lidé MeSH
- minerály krev metabolismus moč MeSH
- nedostatek vitaminu D farmakoterapie MeSH
- nemoci ledvin farmakoterapie MeSH
- potravní doplňky MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Východisko: Porucha kalciumfosfátového metabolizmu sa objavuje v skor/ch štádiách chronických chorôb obličiek a často progreduje do renálnej osteodystrofie so zvýšeným rizikom fraktúr, mimokostných kalcifikácií a kardiovaskulárnej mortality. Kľúčovú úlohu v tomto vývoji zohráva nedostatok vitamínu D. Cieľ: Zistiť bilanciu vitamínu D a ďalších ukazovateľov minerálového a kostného metabolizmu u pacientov s chronickými chorobami obličiek v štádiu 2-4 K/DOQI. Metódy: v súbore 137 ambulantných pacientov s chronickými nefropatiami a clearance kreatinínu (Ckr) 0,25-1,49 ml/s sa stanovili koncentrácie kalcia a fosforu v sére a v moči/24 h. koncentrácie kalcidiolu (25(OH)D3), kalcrtrlolu (1,25(OH)2D3), intaktného parathormónu (iPTH) a vybraných markerov kostného obratu (celková a kostná frakcia alkalickej fosfatázy, osteokalcín a C-terminálny telopeptid kolagénu typu 1) v sére. Výsledky sa porovnali štatisticky podľa štádií K/DOQl. Výsledky: Koncentrácia 25(OH)D3 ako indikátora zásob vitamínu D priamo korelovala s Ckr a rozdiely medzi štádiami K/DOQl boli významné: medián 25(0H)D3 v 2. štádiu bol 20 ng/ml, v 3. štádiu 15 ng/ml a v 4. štádiu 10 ng/ml. Len 19 (14 %) pacientov malo koncentráciu 25(0H)D3 nad dolnou odporúčanou hodnotou 30 ng/ml. 58 (42,6 %) v pásme mierneho deficitu (16-30 ng/ml). 57 (41.9 %) v pásme stredného deficitu (5-15 ng/ml) a 2 pacienti (1,5 %) v pásme ťažkého deficitu (< 5 ng/ml) vitamínu D. Koncentrácia 25(OH)D3 korelovala priamo s 1,25(0H)2D3 a nepriamo s iPTH. Až 40% chor/ch v 3. štádiu, resp. 33% v 4. štádiu malo koncentráciu iPTH nad hornou odporúčanou hranicou 70. resp. 110 pg/ml. Mediány kalciémie a fosfatémie boli vo všetkých 3 štádiách v referenčnom rozmedzí. Z markerov kostného obratu koreloval s iPTH najviac osteokalcín. Záver: Nedostatok vitamínu D a zvýšené koncentrácie iPTH boli prítomné už vo včasných fázach chronických chorôb obličiek a s poklesom Ckr sa zvýrazňovali. U týchto pacientov je potrebná suplementácia vitamínom D, aby sa zabránilo rozvoju sekundárnej hyperparatyreózy a renálnej osteodystrofie.
Background: Calcium-phosphate metabolism disorder occurs in the early stages of chronic renal disease and often progresses to renal osteodystrophy associated with increased risk of fractures, extraosseous calcification and cardiovascular mortality. A key role in this is played by vitamin D deficiency. Aim: To determine the balance of vitamin D and other markers of mineral and bone metabolism in patients with chronic renal disease in stages 2-4 K/DOQl. Methods: 24-h serum and urinary calcium and phosphorus levels, and the serum levels of calcidiol (25(0H)D3), calcitriol (1,25(OH)2D3), intact parathyroid hormone (iPTH) and selected markers of bone turnover (total and bone alkaline phosphatase fractions, osteocalcin, and C-terminal type I collagen telopeptide were determined in a group of 137 outpatients with chronic nephropathy and creatinine clearance of (Ckr) 0.25-1.49 ml/s. Results were compared statistically using K/DOQI stages. Results: The levels of 25(OH)D3 as a marker of vitamin D store correlated directly with Ckr and there were significant differences among K/DOQI stages: the median of 25(OH)D3 was 20 ng/ml in stage 2, being 15 ng/ml in stage 3, and 10 ng/ml in stage 4. Only 19 (14%) of patients showed 25(OH)D3 levels above the lower recommended limit of 30 ng/ml. with 58 (42.6%) patients being in the mild vitamin D deficiency range (16-30 ng/ml), 57 (41.9 %) in the moderate deficiency range (5-15 ng/ml), and 2 patients (1.5%) in the severe deficiency range (< 5 ng/ml). The levels of 25(0H)D3 correlated positively with 1,25(OH)2D3 and negatively with iPTH. Up to 40% and 33% of patients in stages 3 and 4, respectively! had"rPTmeVel7aboveihe upper recommended limits of 70 and 110 pg/ml, respectively. In all 3 stages, the medians of calciemia and phosphatemia were within the reference range. The bone turnover marker showing the closest correlation with iPTH was osteocalcin. Conclusion: Vitamin D deficiency and increased iPTH levels were already present in the early phases of chronic renal disease becoming more pronounced with decreasing Ckr. These patients require vitamin D supplementation to prevent the development of secondary hyperparathyroidism and renal osteodystrophy.
- MeSH
- hypertenze farmakoterapie MeSH
- indapamid aplikace a dávkování terapeutické užití MeSH
- kombinovaná terapie využití MeSH
- lidé MeSH
- perindopril aplikace a dávkování terapeutické užití MeSH
- rozvrh dávkování léků MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
