Abstract
BackgroundLow 25-hydroxy vitamin D (25(OH)D) levels have been associated with an increased risk of albuminuria, however an association with glomerular filtration rate (GFR) is not clear. We explored the relationship between 25(OH)D levels and prevalent chronic kidney disease (CKD), albuminuria and impaired GFR, in a national, population-based cohort of Australian adults (AusDiab Study).Methods10,732 adults ≥25 years of age participating in the baseline survey of the AusDiab study (1999–2000) were included. The GFR was estimated using an enzymatic creatinine assay and the CKD-EPI equation, with CKD defined as eGFR <60 ml/min/1.73 m2. Albuminuria was defined as a spot urine albumin to creatinine ratio (ACR) of ≥2.5 mg/mmol for men and ≥3.5 for women. Serum 25(OH)D levels of <50 nmol/L were considered vitamin D deficient. The associations between 25(OH)D level, albuminuria and impaired eGFR were estimated using multivariate regression models.Results30.7% of the study population had a 25(OH)D level <50 nmol/L (95% CI 25.6-35.8). 25(OH)D deficiency was significantly associated with an impaired eGFR in the univariate model (OR 1.52, 95% CI 1.07-2.17), but not in the multivariate model (OR 0.95, 95% CI 0.67-1.35). 25(OH)D deficiency was significantly associated with albuminuria in the univariate (OR 2.05, 95% CI 1.58-2.67) and multivariate models (OR 1.54, 95% CI 1.14-2.07).ConclusionsVitamin D deficiency is common in this population, and 25(OH)D levels of <50 nmol/L were independently associated with albuminuria, but not with impaired eGFR. These associations warrant further exploration in prospective and interventional studies.
Highlights
Low 25-hydroxy vitamin D (25(OH)D) levels have been associated with an increased risk of albuminuria, an association with glomerular filtration rate (GFR) is not clear
Vitamin D plays an important role in human health, and vitamin D deficiency is commonly observed in the general population and across the spectrum of chronic kidney disease (CKD) [1]
The optimal 25(OH)D levels are not well established and may vary depending on the underlying disease state and population studied. It is not clear how accurately serum 25(OH)D levels reflect local tissue concentrations, which is paramount given the importance of autocrine vitamin D synthesis in mediating its extra-renal effects and proposed benefits
Summary
Low 25-hydroxy vitamin D (25(OH)D) levels have been associated with an increased risk of albuminuria, an association with glomerular filtration rate (GFR) is not clear. We explored the relationship between 25(OH)D levels and prevalent chronic kidney disease (CKD), albuminuria and impaired GFR, in a national, population-based cohort of Australian adults (AusDiab Study). Vitamin D plays an important role in human health, and vitamin D deficiency is commonly observed in the general population and across the spectrum of chronic kidney disease (CKD) [1]. Many extra-renal cells are able to convert the circulating form of vitamin D, 25-hydroxy vitamin D (25(OH)D), into the active form [8]. This has focused research on the autocrine function of vitamin D, and serum 25(OH)D deficiency has emerged as an important independent risk factor for morbidity and mortality, and a potential therapeutic target in CKD
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