期刊
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
卷 97, 期 12, 页码 4780-4788出版社
ENDOCRINE SOC
DOI: 10.1210/jc.2012-2852
关键词
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资金
- National Institute of Diabetes and Digestive and Kidney Diseases [RC4DK090766, R01DK088762, R01HL096875, P30DK035816, P01DK02456]
- National Heart, Lung, and Blood Institute
- Division of Diabetes, Endocrinology and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases
- National Eye Institute
- National Institute of Neurological Disorders and Stroke
- General Clinical Research Centers Program
- Clinical and Translational Science Awards Program, National Center for Research Resources
- Genentech through National Institute of Diabetes and Digestive and Kidney Diseases
- Abbott Laboratories
- Reata Pharmaceuticals
- Eli Lilly
- Novartis Pharmaceuticals
- Novo Nordisk
- Sanofi-Aventis
- Pharma Diagnostic
Context: Impaired vitamin D metabolism may contribute to the development and progression of diabetic kidney disease. Objective: The aim of the study was to test associations of circulating vitamin D metabolites with risks of incident microalbuminuria, impaired glomerular filtration rate (GFR), and hypertension in type 1 diabetes. Design: We performed a cohort study of 1193 participants in the Diabetes Control and Complications Trial (DCCT), a randomized clinical trial of intensive diabetes therapy, and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) Study. We measured plasma concentrations of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D by mass spectrometry at the end of the DCCT and tested associations with incident microalbuminuria, impaired GFR, and hypertension over up to 16 yr of EDIC follow-up. Results: At the time metabolites were measured, mean age was 32.4 yr; mean duration of diabetes, 7.5 yr; mean iothalamate GFR, 132.9 ml/min/1.73 m(2); and geometric mean albumin excretion rate, 11.8 mg/24 h. Over follow-up, 166 cases of microalbuminuria, 54 cases of impaired GFR, and 541 cases of hypertension were observed. Compared with 25(OH)D of at least 30 ng/ml, 25(OH)D below 20 ng/ml was associated with a 65% higher risk of microalbuminuria (95% confidence interval, 7 to 154%) in adjusted analyses. Low concentrations of 24,25-dihydroxyvitamin D, but not 1,25-dihydroxyvitamin D, were also associated with increased risk of microalbuminuria. No circulating vitamin D metabolite was associated with risk of impaired GFR or hypertension. Conclusions: Low plasma concentrations of 25(OH)D and 24,25-dihydroxyvitamin D are associated with increased risk of microalbuminuria in type 1 diabetes. In contrast, we did not find evidence linking impaired vitamin D metabolism to early GFR loss or the development of hypertension. (J Clin Endocrinol Metab 97: 4780-4788, 2012)
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