Abstract
Identification of the accurate risk factor for CKD remains mandatory to combat the high prevalence of diseases. Growing evidence suggests the association of serum vitamin D with diverse health conditions. However, the relationship between vitamin D, intact parathyroid hormone (PTH), and calcium-phosphate metabolism and development of CKD remains controversial. We conduct this cross-sectional observational study to investigate the association between serum 25 (OH) vitamin D, intact PTH, and calcium and phosphate levels with eGFR and albuminuria, as a surrogate marker of CKD, in a community population. A total of 4080 participants were recruited. The mean age was 58.4 ± 13.3 years and 1480 (36.3%) were men. The mean eGFR was 94.1 ± 26.3 mL/min/1.73 m2. The prevalence of CKD was 19.8%. Serum 25 (OH) vitamin D and log intact PTH levels were inversely correlated with eGFR but positively correlated with log albuminuria. Logistic regression analysis identified the log intact PTH as an independent factor associated with eGFR ≤ 60 mL/min/1.73 m2 and proteinuria. This association was consistent when serum intact PTH was analyzed as continuous as well as categorical variables (as hyperparathyroidism). The relationship remains significant using resampling subset analysis with comparable baseline characteristics and adjustment for 25 (OH) vitamin D, calcium, and phosphate levels. This finding warranted further research to clarify the causal relationship of PTH/25 (OH) vitamin D with the risk of CKD in the general population.
Highlights
Chronic kidney disease (CKD) is a worldwide public health issue because of its wide association with multiple comorbidities, demanding high cardiovascular events, mortality, and expensive medical cost
Logistic regression analysis identified the log intact parathyroid hormone (PTH) as an independent factor associated with CKD [crude: odd ratios (OR), 1.985; 95% confidential interval (CI), 1.663–2.371, p < 0.001; model 1: OR, 1.618; 95% CI, 1.345–1.948, p < 0.001; model 2 (adjusted for age, gender, 25 (OH) vitamin D, calcium, and phosphate): OR, 1.796, 95% CI, 1.479–2.181, p < 0.001]
The association of intact PTH with CKD was consistent when assessed in a categorical fashion, as hyperphosphatemia [crude: OR, 2.530; 95% CI, 2.057–3.112, p < 0.001; model 1: OR, 2.074; 95% CI, 1.662–2.589, p < 0.001; model 2 (adjusted for age, gender, 25 (OH) vitamin D status, hypocalcemia, and hyperphosphatemia): OR, 2.128, 95% CI, 1.699–2.667, p < 0.001 (Table 3)]
Summary
Chronic kidney disease (CKD) is a worldwide public health issue because of its wide association with multiple comorbidities, demanding high cardiovascular events, mortality, and expensive medical cost. Ascertainment of accurate risk factors associated with CKD is mandatory to allow timely diagnosis and intervention to decrease the burden of the disease. The associations of CKD with several traditional risk factors (such as hypertension, diabetes, obesity, smoking, dyslipidemia, and metabolic syndrome) were well established in the literature [4]. The interplay between vitamin D, fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (PTH), and calcium-phosphorus-bone metabolism is disrupted with the progression of renal function [13,14,15]. The relationship between vitamin D, intact PTH, and calcium-phosphate metabolism and development of CKD remains controversial
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