Abstract
Aims/Introduction: Chronic kidney disease (CKD)-mineral and bone disorders (CKD-MBD) are an adverse outcome derived from decreases in kidney function, where abnormality of serum concentrations of calcium (Ca), phosphorus, parathyroid hormone (PTH), and vitamin D can be seen simultaneously. To identify individuals at risk for CKD-MBD or secondary hyperparathyroidism, the relationships between estimated glomerular filtration rate (eGFR) and serum PTH concentration were evaluated, allowing for confounding factors, in particular vitamin D status, in a general Japanese population.Materials and Methods: Nine-hundred-and-thirty participants in the population-based Iwaki study conducted in 2016 who were not on drugs affecting mineral metabolism nor hemodialysis, were included in the study (326 men and 604 women; age: 55.4 ± 15.9 years).Results: Regression analysis showed a significant correlation between eGFR and serum intact PTH concentration, after adjustment for possible confounding factors (β = −0.122, p < 0.001). The smoothed spline curve applied for the correlation analysis revealed a biphasic correlation, with a division at an eGFR of ~60 mL/min/1.73 m2, below which the correlation coefficient was higher (β = −0.405, p < 0.001). Stratification on the basis of vitamin D status showed that the correlation was present only in participants with vitamin D deficiency (25-dihydroxyvitamin D3: <15 pg/mL) (β = −0.154, p < 0.001).Conclusions: These results indicate that a reduction in eGFR is a significant risk factor for an increase in serum PTH concentration when it is <60 mL/min/1.73 m2 and vitamin D is deficient, in the general Japanese population.
Highlights
Chronic kidney disease (CKD) is a worldwide public health issue, because CKD is a risk for end-stage kidney disease (ESKD), and for CKD-related mineral and bone disorders (CKD-MBD), as well as cardiovascular events and mortality [1,2,3,4]
We evaluated the relationships between estimated glomerular filtration rate and serum parathyroid hormone (PTH) concentration, allowing for confounding factors, in particular vitamin D status, to identify individuals at risk for CKD-MBD or secondary hyperparathyroidism in a general Japanese population
Most clinical characteristics appeared to be within the normal ranges, the serum 25(OH)VitD3 concentration were slightly low [19.7 ± 7.7 ng/mL; individuals with 25(OH)VitD3
Summary
Chronic kidney disease (CKD) is a worldwide public health issue, because CKD is a risk for end-stage kidney disease (ESKD), and for CKD-related mineral and bone disorders (CKD-MBD), as well as cardiovascular events and mortality [1,2,3,4]. CKD-MBD is a syndrome characterized by dysregulation of minerals and bone metabolism, bone fragility, Interaction Between eGFR and PTH and vascular calcification, each of which has been shown to be associated with greater morbidity and mortality in studies of CKD [5,6,7]. As CKD progresses, the activation of vitamin D decreases, resulting in hypocalcaemia and secondary hyperparathyroidism, which in turn stimulates bone osteoclast activity and generates bone abnormalities. The prevention of secondary hyperparathyroidism or an increase in serum PTH concentration is recommended to ameliorate the bone abnormalities present in patients with ESKD [7, 8]. Therapy aimed at lowering the serum concentration of PTH may be useful, even in patients in the earlier stages of CKD, the effectiveness of such therapy has not been thoroughly assessed. The increase in serum PTH concentration induced by renal dysfunction may depend at least partially on vitamin D status
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