Changes of parathyroid hormone and vitamin D metabolites according to glomerular filtration rate in chronic kidney disease patients

BACKGROUNDS: Disturbances of mineral metabolism are common during the course of chronic kidney disease (CKD) and lead to serious and debilitating complications unless these abnormalities are addressed and treated. While secondary hyperparathyroidism develops during the early stages of chronic kidney disease, few patients are evaluated for elevations in serum parathyroid hormone (PTH) before they become frankly hypocalcemic. Quantification of the prevalence of these abnormalities has not been described using current assays in patients with non-dialysed chronic kidney disease in Korea. MATERIALS AND METHODS: Patients who had documented eGFR<60 mL/min/1.73 m2 and non-dialysed and had not received any vitamin D compounds. eGFR was calculated by simplified MDRD (Modification of Diet in Renal Disease study) equation. Blood samples were collected for serum creatinine, calcium, phosphate, intact PTH, 25-hydroxyvitamin D (25(OH)D3) and 1,25-dihydroxyvitamin D (1,25(OH)2D3) between May 2006 and April 2007. RESULTS: There were 32 patients with CKD stage 3 (30-59 mL/min/1.73 m2), 37 with CKD stage 4 (15-29 mL/min/1.73 m2) and 44 with CKD stage 5 (<15 mL/min/1.73 m2). The prevalence of hyperparathyroidism (iPTH>65 pg/mL) was 56.3% (18/32) in stage 3, 70.3% (26/37) in stage 4 and 95.5% (42/44) in stage 5 patients. The prevalence of 25-hydroxyvitamin D deficiency (25(OH)D3<15 ng/mL) was 86.2% (25/29) in stage 3, 75.7% (28/37) in stage 4 and 88.4% (38/43) in stage 5. The prevalence of 1,25-dihydroxyvitamin D (1,25(OH)2D3)<25 pg/mL) was 22.7% (5/22) in stage 3, 50.0% (6/12) in stage 4 and 62.5% (10/16) in stage 5. Correlation analysis indicated that there was a negative correlation between eGFR and intact PTH (r=-0.531, P=0.000) and a positive correlation between eGFR and 1,25-dihydroxyvitamin D (r=0.587, P=0.000). CONCLUSIONS: These data indicate that vitamin D deficiency and abnormality of parathyroid hormone are prevalent even in the early stage of chronic kidney disease. There are significant correlations of eGFR with intact PTH, 1,25-dihydroxyvitamin D but no correlation between eGFR and 25-hydroxyvitamin D. In non-dialysed CKD patients, quantification of the prevalence of abnormality of intact PTH and vitamin D deficiency has been described in this study in Korea. Future research should be conducted in a prospective, multi-center community cohort study including early stage like CKD 1 and 2.

Author dc:creator

• 유, 수경

Contributors dc:contributor

• 김, 흥수
• 대학원 의학과
• 104844

• 부갑상선호르몬
• 비타민 D
• 만성 신장질환
• vitamin D
• 사구체 여과율

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000002688
000000002688

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/1686