Fayed, A., M. Elnokeety, A. Heikal, H. Hammad, D. Abdulazim, M. Salem, mervat naguib, U. Sharaf, and U. S. El Din, Is 25-Hydroxy Vitamin D a Real Index of Vitamin D Status in Pre-Dialysis Chronic Kidney Disease Patients?, , 2018/02/04. Abstract
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Fayed, A., M. M. El Nokeety, A. A. Heikal, K. M. Sadek, H. Hammad, D. O. Abdulazim, M. M. Salem, and U. A. Sharaf El Din, "Urine albumin and serum uric acid are important determinants of serum 25 hydroxyvitamin D level in pre-dialysis chronic kidney disease patients.", Renal failure, vol. 41, issue 1, pp. 540-546, 2019. Abstract

Low serum 25 hydroxyvitamin D (25 OH D) is common among chronic kidney disease (CKD) patients. This cross-sectional study is looking for the different factors associated with serum 25 OH D among pre-dialysis CKD. 1624 adult stage 3-5 CKD patients were studied beside 200 normal control subjects. All candidates were tested for body mass index (BMI), estimated glomerular filtration rate (eGFR), calcium (Ca), phosphorus (P), parathormone (PTH), 25 OH D, albumin, and uric acid (UA), and urine albumin/creatinine ratio (ACR). Multivariate linear regression analysis was done to determine predictors of 25 OH D. 98.6% of CKD patients have inadequate level of 25 OH D vs 48% of normal subjects. Serum 25 OH D was significantly lower in CKD patients (mean ± S.D = 16.54 ± 5.8 vs 37.79 ± 3.58 ng/mL for CKD vs control group respectively,  < .001). Serum level of 25 OH D has significant positive correlation with Ca ( = 0.337,  < .001), and significant negative correlation with P, PTH, UA, and ACR ( = -0.440, -0. 679, -0.724, and -0.781respectively,  < .001 in all). The independent predictors of 25 OH D were Ca, P, UA, PTH, and ACR (R square = 0.7, β = -0.087, -0.226, -0.313, -0.253, and -0.33 respectively,  < .001 in all). In conclusion, pre-dialysis CKD patients frequently suffer low 25 OH D. Among the different abnormalities related to CKD, urine albumin excretion rate and UA are the most important predictors of 25 OH D in these patients.

Fayed, A., M. M. El Nokeety, A. A. Heikal, K. Marzouk, H. Hammad, D. O. Abdulazim, M. M. Salem, and U. A. Sharaf El Din, "Serum 25-hydroxyvitamin D level is negatively associated with serum phosphorus level among stage 3a-5 chronic kidney disease patients.", Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia, vol. 38, issue 5, pp. 514-519, 2018. Abstract

BACKGROUND: Serum 25-hydroxyvitamin D (25(OH)D) negatively correlates with serum phosphorus level of stage 3a-5 chronic kidney disease (CKD) patients. So far, no explanation has been provided for this negative association.

OBJECTIVE: To confirm this negative association and determine if this relationship is mediated through other known co-morbid factors.

CASES AND METHODS: One hundred (57 male and 43 female) pre-dialysis stage 3a-5 CKD patients were selected. Estimated glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), 25(OH)D, parathyroid hormone (PTH), and intact fibroblast growth factor-23 (FGF23) were assessed. A correlation analysis between serum 25(OH)D and the different parameters studied was performed. Multivariate linear regression analysis was carried out to determine predictors of 25(OH)D.

RESULTS: The negative association between serum 25(OH)D and serum P was confirmed in univariate and multivariate correlation analysis. On the other hand, we failed to detect a significant association between 25(OH)D and serum FGF23. Serum P is the most important independent predictor of 25(OH)D in these patients (partial R=0.15, p<0.0001).

CONCLUSION: Serum P is likely to have a direct negative impact on serum 25(OH)D. Further studies are needed to determine the underlying mechanism.

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