Document Detail

Cross-sectional analysis of abnormalities of mineral homeostasis, vitamin D and parathyroid hormone in a cohort of pre-dialysis patients. The chronic renal impairment in Birmingham (CRIB) study.
MedLine Citation:
PMID:  17890873     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Disturbances in mineral and vitamin D metabolism, which affect parathyroid hormone (PTH) synthesis, are well recognized in patients receiving dialysis. However, it is unclear at what stage of chronic kidney disease (CKD) these abnormalities develop.
METHODS: The associations between CKD stages 3 and 5, and alterations of calcium, phosphate, vitamin D and PTH concentrations were assessed in 249 patients (mean age 61 years, 66% male) and 79 age- and sex-matched healthy controls.
RESULTS: As compared to controls, serum phosphate concentrations were elevated among CKD patients (1.40 vs. 1.11 mmol/l; p < 0.0001). And levels of both 25-hydroxyvitamin D (42.1 vs. 60.4 nmol/l; p < 0.0001) and 1,25-dihydroxyvitamin D (58.2 vs. 119.5 pmol/l; p < 0.0001) were lower among patients with CKD, even among those with only stage 3 CKD and despite 73% of patients receiving vitamin D supplements. The ratio of 1,25-dihydroxy- to 25-hydroxyvitamin D was lower than controls, even among patients with stage 3 CKD (p = 0.0001), and this ratio diminished with advancing renal impairment. Concomitant elevations were observed in intact PTH (13.8 vs. 4.2 pmol/l; p < 0.0001) and whole PTH (7.9 vs. 2.7 pmol/l; p < 0.0001).
CONCLUSION: Impaired conversion of 25-hydroxy- to 1,25-dihydroxyvitamin D is an early feature of renal disease, and progresses as renal function deteriorates.
Daniel Zehnder; Martin J Landray; David C Wheeler; William Fraser; Lisa Blackwell; Sarah Nuttall; Sue V Hughes; John Townend; Charles Ferro; Colin Baigent; Martin Hewison
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-09-21
Journal Detail:
Title:  Nephron. Clinical practice     Volume:  107     ISSN:  1660-2110     ISO Abbreviation:  Nephron Clin Pract     Publication Date:  2007  
Date Detail:
Created Date:  2007-11-06     Completed Date:  2007-12-06     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  101159763     Medline TA:  Nephron Clin Pract     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  c109-16     Citation Subset:  IM    
Copyright Information:
(c) 2007 S. Karger AG, Basel.
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MeSH Terms
Calcium / blood*
Cross-Sectional Studies
Hyperparathyroidism / blood*,  etiology
Kidney Failure, Chronic / blood*,  complications,  rehabilitation
Middle Aged
Minerals / blood
Parathyroid Hormone / blood*
Phosphates / blood*
Renal Dialysis / adverse effects*
Vitamin D / blood*
Vitamin D Deficiency / blood*,  etiology
Grant Support
MC_U137686853//Medical Research Council; MC_U137686860//Medical Research Council; PG/11/66/28982//British Heart Foundation
Reg. No./Substance:
0/Minerals; 0/Parathyroid Hormone; 0/Phosphates; 1406-16-2/Vitamin D; SY7Q814VUP/Calcium

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