Correlations between the levels of vitamin D, parathormone, calcium, blood phosphates in patients with chronic disease of the kidneys untreated with replacement renal therapy

Abstract

Aim. To characterize correlations between the levels of vitamin D, parathormone, calcium, blood phosphates in patients with different stages of chronic disease of the kidney (CDK) given no therapy replacing renal function (TRRF).
Material and methods. Serum levels of creatinine, electrolytes, parathormone (PTH), 25(OH)-vitamin D (calcidiol -CD), 1,25 (OH)2-vitamin D (calcitriol -CT), calcium (Ca) and phosphates (P) excretion with urine were studied in 465 patients aged 52.2 ± 15.5 years with CDK stage I-V given no TRRF having mean glomerular filtration rate (GFR) 51.8 ± 27.1 ml/min.
Results. A CT level lowered with CDK progression and directly correlated with GFR, blood levels of Ca and CD. Correlation with PTH was not found. CD did not correlate with GFR. PTH rose from stage II CDK and its concentration in the blood correlated negatively with GFR, blood Ca (in lesser degree), directly correlated with P. Ca lowered at stage V of CDK, P - at stage II, increased at stage IV. In reduction of GFR 24-h excretions of P and Ca diminished in spite of growth of their excreted fractions and were related directly with CT.
Conclusion. A rise of PTH and fall of CT occur at early CDK stages. P disbolism seems to play a key role in genesis of hyperparathyrosis. We are the first to show lowering of 24-hour Ca and P excretioin with CDK progression which may be caused by a progressive CT deficiency.

References

  1. Sarnak M. J., Levey A. S., Schoolwerth A. C. et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research. Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003; 42 (5): 1050-1065.
  2. Vanholder R., Massy Z., Argiles A. et al. Chronic kidney disease as cause of cardiovascular morbidity and mortality. Nephrol. Dial. Transplant. 2005: 20 (6): 1048-1056.
  3. Levin A., Bakris G. L., Molitch M. et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007; 71: 31-38.
  4. Li Y. C., Kong J., Wei M. et al. 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J. Clin. Invest. 2002; 110: 229-238.
  5. Mathieu C., Adorini I. The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents. Trends Mol. Med. 2002: 8 (4): 174-179.
  6. Park C. W., Oh Y. S., Shin Y. S. et al. Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am. J. Kidney Dis. 1999; 33 (1): 73-81.
  7. Timms P. M., Mannan N., Hitman G. A. et al. Circulating MMP9, vitamin D and variation in the TIMP-I response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? Quart. J. Med. 2002; 95 (12): 787-796.
  8. Emanuel V., Smirnov A., Volkov M. et al. Vitamin D deficiency in chronic kidney disease patients prior to dialysis is associated with heart valve calcification. In: XXXI Nordic congress in clinical chemistry (Labmed); Abstracts. 2008. 93.
  9. Zittermann A., Schleithoff S. S., Tenderich G. et al. Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J. Am. Coll. Cardiol. 2003; 41 (1): 105-112.
  10. Kovesdy C. P., Kalantar-Zadeh K. Vitamin D receptor activation and survival in chronic kidney disease. Kidney Int. 2008; 73 (12): 1355-1363.
  11. Волков М. М., Дегтярева О. А., Шевякова Е. В. Факторы, связанные с кальцинацией клапанного аппарата сердца у пациентов на хроническом гемодиализе. Нефрология 2007; 11 (3): 57-63.
  12. Block G. A., Hulbert-Shearon T. E., Levin N. W., Port L. K. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am. J. Kidney Dis. 1998; 31 (4): 607-617.
  13. Teng M., Wolf M., Lowrie E. et al. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N. Engl. J. Med. 2003; 349 (5): 446-456.
  14. Norman A. W. Vitamin D metabolism and calcium absorption. Am. J. Med. 1979; 67 (6): 989-998.
  15. Ермоленко В. М. Фосфорно-кальциевый обмен и почки. В кн.: Тареева И. Е. (ред.). Нефрология: Руководство для врачей. М.: Медицина; 2000. 62-75.
  16. Agarwal R., Acharya M., Tian J. et al. Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney Int. 2005; 68 (6): 2823-2828.
  17. Cantley L. K., Russell J., Lettieri D., Sherwood L. M. 1.25-dihydroxyvitamin D3 suppresses parathyroid hormone secretion from bovine parathyroid cells in tissue culture. Endocrinology 1985: 117 (5): 2114-2119.
  18. Slatopolsky L., Finch J., Denda M. et al. Phosphorus restriction prevents parathyroid gland growth. High phosphorus directly stimulates PTH secretion in vitro. J. Clin. Invest. 1996: 97 (11): 2534-2540.
  19. Naveh-Many T., Rahamimov R., Livni N., Silver J. Parathyroid cell proliferation in normal and chronic renal failure rats. The effects of calcium, phosphate, and vitamin D. J. Clin. Invest. 1995: 6 (4): 1786-1793.
  20. Tanaka Y., Deluca H. F. The control of 25-hydroxyvitamin D metabolism by inorganic phosphorus. Arch. Biochem. Biophys. 1973; 154 (2): 566-574.
  21. Brown A. J., Ritter C. S., Finch J. L., Slatopolsky E. A. Decreased calcium-sensing receptor expression in hyperplastic parathyroid glands of uremic rats: role of dietary phosphate. Kidney Int. 1999; 55 (4): 1284-1292.
  22. Bricker N. S. On the pathogenesis of the uremic state. An exposition of the "trade-off hypothesis". N. Engl. J. Med. 1972; 286 (20): 1093-1099.

Copyright (c) 2009 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies