Vitamin D insufficiency evident in patients with diabetes, CKD

NASHVILLE, Tenn. - Patients with diabetes showing signs of chronic kidney disease have significantly lower levels of vitamin D compared with patients with diabetes and better kidney function, according to study findings presented here.

In a retrospective study, Michael Marchese, MD, and Subashini Yaturu, MD, of Stratton VA Medical Center and Albany Medical College in New York, and colleagues analyzed data from the 64,144 veterans (27,098 with diabetes; mean age, 68 years) who had 25-hydroxyvitamin D levels and 1,25(OH)D levels measured between 2006 and 2009. Researchers used the electronic patient record system at Stratton Veterans Health Administration to collect demographic information, including age, sex, BMI and race, as well as clinical and laboratory data.

Mean 25-(OH)D level among patients with diabetes was 27 ± 11.6 ng/mL. Vitamin D deficiency is defined as serum 25-(OH)D levels of less than 20 ng/mL; insufficiency is defined as levels of 20 ng/mL to 30 ng/mL.

In patients with an estimated glomerular filtration rate less than 50 mL/min/1.73 m2, 1,25(OH)D levels were significantly lower (22 ng/mL) and the parathyroid hormone level was significantly elevated (163 pg/mL) compared with patients with an eGFR more than 50 mL/min/1.73 m2 (1,25[OH]D, 34 ng/mL; parathyroid hormone, 69 pg/mL).

Patients in the cohort with end-stage renal disease (n = 580) and those with ESRD and diabetes (n = 407) both had vitamin D levels in the insufficiency range that was not affected by the presence or lack of diabetes, according to researchers. Vitamin D deficiency was associated with higher BMI, mildly elevated parathyroid hormone and significantly higher HbA1c levels.

“Physicians should consider checking vitamin D levels in diabetic patients with CKD or poor glycemic control as this can be easily replaced,” Marchese told Endocrine Today. “Further studies need to be completed on the possible causes of Vitamin D in this population, such as malabsorption.”

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