The Serum Level Of 25-hydroxivitamin D And Correlation Analysis In Patients With Chronic Kidney Disease

Objective: In recent years the incidence of chronic kidney disease(CKD) is more and more high, mineral and bone metabolic abnormalities(MBD) chronic kidney disease(CKD) is one of the major complications of chronic kidney disease(CKD).CKD-MBD can be found in the early CKD. However, there is no sensitive biochemical makers can diagnose CKD-MBD. Glucocorticoid(GC) has become the most efficacious treatment for most nephrotic syndrome patients. Studies have shown that GC can increase the progress of CKD-MBD, even happen of glucocorticoid-induced osteoporosis(GIOP). In our survey, we aim to investigate the level of larger sample of 25-hydroxivitamin D3 in non-dialyzed patients’ serum which can provide clues for early diagnosis of CKD-MBD. At the same time, we observed the level of 25-hydroxivitamin D3 and the protective effect of the skeletal system in chronic kidney disease patients who take different doses of GC.Methods: inclusion criteria:(1)Selection in March 2013 to March 2015 in the first affiliated hospital of Dalian Medical University renal medicine hospitalized patients with chronic kidney disease(CKD).all the patients conform the definition of United States kidney disease/dialysis clinical practice guidelines。(2)Older than 18 years old.Exclusion criteria: Bone tumors or congenital dysplasia of bone;Late tumor;Serious liver disease; Severe blood system diseases, such as leukemia, lymphoma, multiple myeloma, etc;Rheumatoid arthritis(Ra). Renal tubular acidosis, Fanconi syndrome caused by bone disease, Paralyzed in bed for a history or who cannot accept theinspection and test. All patients had signed informed consent form, this study scheme scholastic ethics committee approval(approval number LCKY2014-02). In accordance with the nephrotic syndrome diagnostic criteria CKD1-2stage patients can be divided into two groups. Nephrotic syndrome group(NS group) and non-nephrotic syndrome group(NNS). The patients who need long-term and high-dose taking GC given calcitriol combined therapy with calcium carbonate(600mg daily oral) six months and randomly divided into 0.25 ug of calcitriol group and 0.5ug of calcitriol group, before and after taking calcitriol, we detect the serum 25(OH) D levels and bone mineral density. Statistical analysis was done by using t test, single factor analysis of variance, Pearson correlation analysis, Spearman correlation analysis.Result: All patients with chronic kidney disease(CKD) compared with control group of 25(OH)D(8.55±7.23vs13.92±4.18)ng/ml,significant decrease(P<0.01),CT(3.22±2.98vs2.30±1.09)pg/ml、N-MID(48.4±66.9vs17.08±5.84)ng/ml、β-CTX(1.0±0.97vs0.52±0.25)ng/ml、t PINP(116.7±165.9vs53.45±20.37)Significantly increased(average P<0.01)。CKD1-5 respectively compared with control group,Serum 25(OH)D are reduced(P<0.05),CKD2 period and the 4 to 5 period reduced more obvious( P < 0.01), CKD2 period compared with the CKD4-5 period is significantly reduced。CKD1-5 comparison between groups: serum levels of N-MID,t PINP, CT in CKD1-3 period compared with control group, respectively, had no obvious difference, CKD4 group to rise( P < 0.05), CKD5 rise more obvious(P<0.01) 。 β-CTX in CKD1-3 period had no obvious difference compared with controls, respectively, CKD4-5 increased significantly(P<0.01). CKD1-4, compared with phase CKD5 group, respectively, serum levels of N-MID, t PINP, β-CTX and CT were statistically significant. Serum levels of N-MID, t PINP, β-CTX, CT in CKD1-3period had no obvious difference compared with each group, Comparison between the CKD3-5 groups, along with the e GFR decreased, N-MID, t PINP, β-CTX, CT increased. In patients treated with GC, 25(OH)D with the increase of the total GC hasdecreased, but no significant correlation. In patients treated with calcitriol ug 0.5 GC25(OH)D significantly increased after treatment(p=0.038),t PINP、β-CTX、N-MID had no obvious change. Taking 0.25 ug calcitriol group and 0.5 ug before and after the treatment with GC, lumbar L1-4 bone mineral density T value and femoral neck bone mineral density T value has increased, but the change is not obvious.Conclusion: The serum of CKD patients 25(OH)D level is lower than that of healthy people, associated with Ca, ALP positively. When NS patients with GC therapy, the protective effect of the skeletal system with oral 0.5ug group of 25(OD)D is higher than before.