{"title":"缺乏维生素 D 可能会增加糖尿病患者发生急性肾损伤的风险,并预示着急性肾损伤患者的预后较差。","authors":"Xiao-Hua Li, Yu-Zhen Luo, Man-Qiu Mo, Tian-Yun Gao, Zhen-Hua Yang, Ling Pan","doi":"10.1186/s12882-024-03781-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Backgound: </strong>People with diabetes are much more likely to develop acute kidney injury (AKI) than people without diabetes. Low 25-hydroxy-vitamin D [25(OH)D] concentrations increased the risk of AKI in specific populations. Few studies have explored the relationship between the 25(OH)D level and AKI in patients with diabetes. We conducted this study to investigate the relationship between the plasma level of 25(OH)D and the risk of AKI in patients with diabetes, and to evaluate whether the 25(OH)D level could be a good prognostic marker for AKI progression.</p><p><strong>Methods: </strong>A total of 347 patients with diabetes were retrospectively reviewed. The primary endpoint was the first event of AKI. The secondary endpoint is need-of-dialysis. AKI patients were further followed up for 6 months with the composite endpoint of end-stage renal disease (ESRD) or all-cause death. Kaplan-Meier survival analysis and Cox proportional hazards models were used.</p><p><strong>Results: </strong>During a median follow-up of 12 weeks (12.3 ± 6.7), 105 incident AKI were identified. The middle and high tertiles of baseline 25(OH)D levels were associated with a significantly decreased risk of AKI and dialysis compared to the low tertile group (HR = 0.25, 95% CI 0.14-0.46; HR = 0.24, 95% CI 0.13-0.44, respectively, for AKI; HR = 0.15; 95% CI 0.05-0.46; HR = 0.12; 95% CI 0.03-0.42, respectively, for dialysis). Sensitivity analysis revealed similar trends after excluding participants without history of CKD. Furthermore, AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death (HR, 4.24; 95% CI, 1.80 to 9.97, P < 0.001).</p><p><strong>Conclusion: </strong>A low 25 (OH) vitamin D is associated with a higher risk of AKI and dialysis in patients with diabetes. AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"333"},"PeriodicalIF":2.2000,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460229/pdf/","citationCount":"0","resultStr":"{\"title\":\"Vitamin D deficiency may increase the risk of acute kidney injury in patients with diabetes and predict a poorer outcome in patients with acute kidney injury.\",\"authors\":\"Xiao-Hua Li, Yu-Zhen Luo, Man-Qiu Mo, Tian-Yun Gao, Zhen-Hua Yang, Ling Pan\",\"doi\":\"10.1186/s12882-024-03781-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Backgound: </strong>People with diabetes are much more likely to develop acute kidney injury (AKI) than people without diabetes. Low 25-hydroxy-vitamin D [25(OH)D] concentrations increased the risk of AKI in specific populations. Few studies have explored the relationship between the 25(OH)D level and AKI in patients with diabetes. We conducted this study to investigate the relationship between the plasma level of 25(OH)D and the risk of AKI in patients with diabetes, and to evaluate whether the 25(OH)D level could be a good prognostic marker for AKI progression.</p><p><strong>Methods: </strong>A total of 347 patients with diabetes were retrospectively reviewed. The primary endpoint was the first event of AKI. The secondary endpoint is need-of-dialysis. AKI patients were further followed up for 6 months with the composite endpoint of end-stage renal disease (ESRD) or all-cause death. Kaplan-Meier survival analysis and Cox proportional hazards models were used.</p><p><strong>Results: </strong>During a median follow-up of 12 weeks (12.3 ± 6.7), 105 incident AKI were identified. The middle and high tertiles of baseline 25(OH)D levels were associated with a significantly decreased risk of AKI and dialysis compared to the low tertile group (HR = 0.25, 95% CI 0.14-0.46; HR = 0.24, 95% CI 0.13-0.44, respectively, for AKI; HR = 0.15; 95% CI 0.05-0.46; HR = 0.12; 95% CI 0.03-0.42, respectively, for dialysis). Sensitivity analysis revealed similar trends after excluding participants without history of CKD. Furthermore, AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death (HR, 4.24; 95% CI, 1.80 to 9.97, P < 0.001).</p><p><strong>Conclusion: </strong>A low 25 (OH) vitamin D is associated with a higher risk of AKI and dialysis in patients with diabetes. AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death.</p>\",\"PeriodicalId\":9089,\"journal\":{\"name\":\"BMC Nephrology\",\"volume\":\"25 1\",\"pages\":\"333\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-10-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460229/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12882-024-03781-x\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12882-024-03781-x","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:糖尿病患者发生急性肾损伤(AKI)的几率远远高于非糖尿病患者。在特定人群中,25-羟基维生素 D [25(OH)D] 浓度低会增加急性肾损伤的风险。很少有研究探讨 25(OH)D 水平与糖尿病患者 AKI 之间的关系。我们进行了这项研究,以探讨糖尿病患者血浆中 25(OH)D 水平与 AKI 风险之间的关系,并评估 25(OH)D 水平是否可作为 AKI 进展的良好预后标志物:方法: 共对 347 名糖尿病患者进行了回顾性研究。主要终点是首次发生 AKI。次要终点是透析需求。对 AKI 患者进一步随访 6 个月,以终末期肾病 (ESRD) 或全因死亡为综合终点。采用卡普兰-梅耶生存分析和考克斯比例危险模型:中位随访时间为 12 周(12.3 ± 6.7),共发现 105 例 AKI。与低三分位组相比,基线25(OH)D水平的中高三分位组发生AKI和透析的风险显著降低(AKI的HR = 0.25,95% CI 0.14-0.46;HR = 0.24,95% CI 0.13-0.44;透析的HR = 0.15;95% CI 0.05-0.46;HR = 0.12;95% CI 0.03-0.42)。敏感性分析显示,在排除无慢性肾脏病病史的参与者后,趋势相似。此外,25(OH)D 缺乏的 AKI 患者发生 ESRD 或全因死亡的风险较高(HR,4.24;95% CI,1.80-9.97,P 结论):25 (OH) 维生素 D 低与糖尿病患者发生 AKI 和透析的风险较高有关。缺乏 25(OH)D 的 AKI 患者发生 ESRD 或全因死亡的风险更高。
Vitamin D deficiency may increase the risk of acute kidney injury in patients with diabetes and predict a poorer outcome in patients with acute kidney injury.
Backgound: People with diabetes are much more likely to develop acute kidney injury (AKI) than people without diabetes. Low 25-hydroxy-vitamin D [25(OH)D] concentrations increased the risk of AKI in specific populations. Few studies have explored the relationship between the 25(OH)D level and AKI in patients with diabetes. We conducted this study to investigate the relationship between the plasma level of 25(OH)D and the risk of AKI in patients with diabetes, and to evaluate whether the 25(OH)D level could be a good prognostic marker for AKI progression.
Methods: A total of 347 patients with diabetes were retrospectively reviewed. The primary endpoint was the first event of AKI. The secondary endpoint is need-of-dialysis. AKI patients were further followed up for 6 months with the composite endpoint of end-stage renal disease (ESRD) or all-cause death. Kaplan-Meier survival analysis and Cox proportional hazards models were used.
Results: During a median follow-up of 12 weeks (12.3 ± 6.7), 105 incident AKI were identified. The middle and high tertiles of baseline 25(OH)D levels were associated with a significantly decreased risk of AKI and dialysis compared to the low tertile group (HR = 0.25, 95% CI 0.14-0.46; HR = 0.24, 95% CI 0.13-0.44, respectively, for AKI; HR = 0.15; 95% CI 0.05-0.46; HR = 0.12; 95% CI 0.03-0.42, respectively, for dialysis). Sensitivity analysis revealed similar trends after excluding participants without history of CKD. Furthermore, AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death (HR, 4.24; 95% CI, 1.80 to 9.97, P < 0.001).
Conclusion: A low 25 (OH) vitamin D is associated with a higher risk of AKI and dialysis in patients with diabetes. AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death.
期刊介绍:
BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.