Estimated GFR and circulating 24,25-dihydroxyvitamin D3 concentration: A participant-level analysis of 5 cohort studies and clinical trials

Ian H. De Boer, Michael C. Sachs, Michel Chonchol, Jonathan Himmelfarb, Andrew N. Hoofnagle, Joachim H. Ix, Robin A. Kremsdorf, Yvonne S. Lin, Rajnish Mehrotra, Cassianne Robinson-Cohen, David S. Siscovick, Michael W. Steffes, Kenneth E. Thummel, Russell P. Tracy, Zhican Wang, Bryan Kestenbaum

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Abstract

Background Decreased glomerular filtration rate (GFR) leads to reduced production of 1,25-dihydroxyvitamin D3 from 25-hydroxyvitamin D 3 (25[OH]D3). Effects of low GFR on vitamin D catabolism are less well understood. We tested associations of estimated GFR (eGFR) with the circulating concentration of 24,25-dihydroxyvitamin D3 (24,25[OH]2D3), the most abundant product of 25(OH)D 3 catabolism, across populations with a wide range of GFRs. Study Design Cross-sectional study. Setting & Participants 9,596 participants in 5 cohort studies and clinical trials: the Diabetes Control and Complications Trial (N = 1,193), Multi-Ethnic Study of Atherosclerosis (N = 6,470), Cardiovascular Health Study (N = 932), Seattle Kidney Study (N = 289), and Hemodialysis Study (N = 712). Predictor eGFR. Outcome Circulating 24,25(OH) 2D3 concentration. Measurements GFR was estimated from serum creatinine using the Chronic Kidney Disease Epidemiology Collaboration equation. Vitamin D metabolites were measured by mass spectrometry. Results Circulating 24,25(OH)2D3 concentration was correlated with circulating 25(OH)D3 concentration (Pearson r range, 0.64-0.88). This correlation was weaker with lower eGFRs. Moreover, the increment in 24,25(OH)2D3 concentration associated with higher 25(OH)D3 concentration (slope) was lower with lower eGFRs: 2.06 (95% CI, 2.01-2.10), 1.77 (95% CI, 1.74-1.81), 1.55 (95% CI, 1.48-1.62), 1.17 (95% CI, 1.05-1.29), 0.92 (95% CI, 0.74-1.10), 0.61 (95% CI, 0.22-1.00), and 0.37 (95% CI, 0.35-0.39) ng/mL of 24,25(OH)2D3 per 10 ng/mL of 25(OH)D3 for eGFRs ≥ 90, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73 m2 and end-stage renal disease treated with hemodialysis, respectively. As a result, at a 25(OH)D3 concentration of 20 ng/mL, mean 24,25(OH)2D3 concentrations were 2.92 (95% CI, 2.87-2.96), 2.68 (95% CI, 2.64-2.72), 2.35 (95% CI, 2.26-2.45), 1.92 (95% CI, 1.74-2.10), 1.69 (95% CI, 1.43-1.95), 1.14 (95% CI, 0.62-1.66), and 1.04 (95% CI,1.02-1.07) ng/mL for each category, respectively. This interaction was independent of other relevant clinical characteristics. Race, diabetes, urine albumin excretion, and circulating parathyroid hormone and fibroblast growth factor 23 concentrations more modestly modified the association of 24,25(OH)2D3 with 25(OH)D3. Limitations Lack of direct pharmacokinetic measurements of vitamin D catabolism. Conclusions Lower eGFR is associated strongly with reduced vitamin D catabolism, as measured by circulating 24,25(OH)2D3 concentration.

Original languageEnglish (US)
Pages (from-to)187-197
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume64
Issue number2
DOIs
StatePublished - Aug 2014

Keywords

  • 1,25-dihydroxyvitamin D3
  • 25-hydroxyvitamin D3
  • Decreased renal function
  • Index Words
  • active vitamin D
  • biomarker
  • chronic kidney disease (CKD)
  • low estimated glomerular filtration rate
  • vitamin D catabolism

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    De Boer, I. H., Sachs, M. C., Chonchol, M., Himmelfarb, J., Hoofnagle, A. N., Ix, J. H., Kremsdorf, R. A., Lin, Y. S., Mehrotra, R., Robinson-Cohen, C., Siscovick, D. S., Steffes, M. W., Thummel, K. E., Tracy, R. P., Wang, Z., & Kestenbaum, B. (2014). Estimated GFR and circulating 24,25-dihydroxyvitamin D3 concentration: A participant-level analysis of 5 cohort studies and clinical trials. American Journal of Kidney Diseases, 64(2), 187-197. https://doi.org/10.1053/j.ajkd.2014.02.015