Sex differences in the association between vitamin D and early-stage chronic kidney disease: A population-based study
Nutrition Research Volume 117, September 2023, Pages 48-55 https://doi.org/10.1016/j.nutres.2023.05.004 PDF behind Paywall
Ting-An Yang a b, Jau-Yuan Chen a c, Chieh-An Lin a, Yi-Chuan Chen a c, Wei Yu d, Hsiung Ying Huang e, Xue-Jie Xiong f, Wen-Cheng Li a c d
Vitamin D deficiency (VDD) is commonly observed in people with late-stage chronic kidney disease (CKD) and end-stage renal disease; it has also been associated with the progression of kidney disease. We hypothesized that VDD played a role in early-stage chronic kidney disease as well. Thus, this cross-sectional study aimed to evaluate the association between serum 25-hydroxyvitamin D concentration and CKD stages 1 through 3 (early-stage CKD) in a relatively healthy population in China. A total of 3142 Chinese individuals were included in this cross-sectional study. VDD was observed in 108 (5.6%) males and 307 (25.33%) females. We found a significant inverse association between serum 25(OH)D concentration with CKD stages in both sexes. Furthermore, VDD was associated with CKD stages 1 through 3 in males (adjusted odds ratio, 15.84; 95% confidence interval, 7.85-31.98; P < .001), but not in females. Vitamin D status should be evaluated in people who are newly diagnosed with CKD stages 1 through 3 or decreased estimated glomerular filtration rate, especially in males.
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Introduction
Vitamin D deficiency (VDD) is commonly observed in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Overweight and obesity are also known to relate to VDD in previous review articles [1,2]. In countries with high obesity rates, such as the United States, VDD prevalence among CKD population was high. It was reported that VDD prevalence in CKD populations is as high as 80% in the United States [3]. Yet, in Asian countries, with relatively low rates of obesity, VDD status in CKD groups remained undefined. VDD further leads to diseases in multiple organ systems. Consequently, secondary hyperparathyroidism tends to occur in patients with CKD and ESRD and cause tertiary hyperparathyroidism, along with its complications. Moreover, decreased serum 25-hydroxyvitamin D (25(OH)D) concentration are associated with insulin resistance and subsequently diabetes mellitus initiated by the inflammation and death of beta cells in the pancreas [4,5]. Recent studies have further proven that lower serum 25(OH)D is associated with the progression of kidney disease as well as cardiovascular and all-cause mortality [6], [7], [8], [9], yet the mechanism and causal relationship has not been well-established. The essential role of vitamin D supplementation has also been demonstrated in several research studies and recent guidelines have suggested it for patients with CKD [10], [11], [12], [13].
Current studies and clinical care focus more on the late stages of CKD and ESRD to prevent secondary hyperparathyroidism. A study in Australia by Isakova et al. [14] demonstrated the relationship between the incidence of albuminuria and reduced estimated glomerular filtration rate (eGFR), yet another study in Australia revealed that low serum 25(OH)D concentration was associated with albuminuria independently without impaired eGFR [15]. A lack of consensus on the relationship between serum 25(OH)D concentration and possibly reduced eGFR has led to controversies over vitamin D supplementation for protecting renal function. On the other hand, the difference of VDD prevalence between sexes has been demonstrated in previous studies [16], [17], [18], [19], [20], [21]. When investigating the relationship between VDD and CKD, it is imperative to consider sex as an important factor.
Except for studies on patients with an apparent VDD, few studies have provided the association between serum 25(OH)D concentration and nutrition status, and even fewer studies have focused on Asian populations. Thus, VDD prevalence and severity remain unclear in patients with CKD stages 1 through 3 in the selected population. Therefore, the study hypothesized that VDD would be associated with early stages of CKD. The objects of this cross-sectional study were: (1) to investigate the prevalence of possible vitamin D insufficiency (VDI) and VDD in the selected population and (2) to determine whether there is a sex difference in the association between serum 25(OH)D concentration and CKD stages 1 through 3.
Section snippets
Study subjects
Data of Chinese individuals aged older than 18 years who had visited the clinic for health examination between 2013 and 2015 were retrospectively collected from Xiamen Chang Gung Hospital. We excluded subjects with pregnancy, space-occupying lesions of kidney or autoimmune nephropathy (such as renal cyst, renal stone, or glomerulonephritis), thyroid function disorders, parathyroid function disorders, pituitary gland diseases, adrenal gland diseases, vitamin D metabolic diseases…
Results
A total of 3142 participants were included in the study period between 2013 and 2015, composed of 1930 males (61.43%) and 1212 females (38.57%). Table 1 demonstrates the main demographic and clinical features of all participants, as well as those stratified by sex. Females were older (P < .001) and had lower BMI (P < .001), mean arterial pressure (MAP; P < .001), fasting glucose (P < .001), triglycerides (P < .001), and low-density lipoprotein cholesterol (P = .003) than their male…
Discussion
In this cross-sectional study, the results revealed a significant inverse association between serum 25(OH)D concentration and early-stage CKD in the selected Chinese population. Moreover, we observed that the adjusted odds ratio of early-stage CKD was significantly higher in male participants with VDD than in those with 25(OH)D concentration >32 ng/mL. These findings suggested that individuals with VDD are more likely to have coexisting CKD than those with normal 25(OH)D concentration or VDI. A …
Conclusions
Our study demonstrated that VDD was independently associated with early-stage CKD among males. Clinicians should consider evaluating vitamin D status among patients newly diagnosed with decreased eGFR or early-stage CKD, particularly those who have kidney disease caused by diabetic nephropathy….
Some References
- Prevalence of calcidiol deficiency in CKD: a cross-sectional study across latitudes in the United States
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- 25-Hydroxyvitamin D levels and albuminuria in the Third National Health and Nutrition Examination Survey (NHANES III)
- Vitamin D levels and patient outcome in chronic kidney disease
- Vitamin D levels and early mortality among incident hemodialysis patients
- Serum 25-hydroxyvitamin D deficiency and the 5-year incidence of CKD
- Defective renal maintenance of the vitamin D endocrine system impairs vitamin D renoprotection: a downward spiral in kidney disease
- Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)
- Kidney disease and vitamin D levels: 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and VDR activation
- Severe vitamin D deficiency is a risk factor for renal hyperfiltration
- Influence of sex on the progression of chronic kidney disease
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- Caring for Australasians with Renal I. The CARI guidelines. Management of bone disease, calcium, phosphate and parathyroid hormone
- Nephrology (Carlton).
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Vitamin D Life – Chronic Kidney contains
Chronic Kidney Disease decreases Vitamin D level in 4 ways
4X more Chronic Kidney disease patients are now using vitamin D – March 2014
Vitamin D testers have different test results if there is chronic kidney disease – Sept 2019
Kidney dialysis often filters out vitamin D
Low vitamin D causes many health problems, such as weak bones
Want to have good Vitamin D levels to prevent CKD from causing other health problems
Higher vitamin D levels can treat CKD 50 ng 80 ng
Monthly dosing appears better than daily for CKD and many other health problems
CKD also decreases Vitamin K2-7
Form of vitamin D to be used; normal, Calcitriol, or synthetic
Non-oral form is often better for CKD ( topical, emulsion swished in mouth, patch cream, etc)