dc.contributor.author | Shroff, Rukshana | |
dc.contributor.author | Aitkenhead, Helen | |
dc.contributor.author | Costa, Nikola | |
dc.contributor.author | Trivelli, Antonella | |
dc.contributor.author | Litwin, Mieczyslaw | |
dc.contributor.author | Picca, Stefano | |
dc.contributor.author | Anarat, Ali | |
dc.contributor.author | Sallay, Peter | |
dc.contributor.author | Ozaltin, Fatih | |
dc.contributor.author | Zurowska, Aleksandra | |
dc.contributor.author | Jankauskiene, Augustina | |
dc.contributor.author | Montini, Giovanni | |
dc.contributor.author | Charbit, Marina | |
dc.contributor.author | Schaefer, Franz | |
dc.contributor.author | Wuehl, Elke | |
dc.date.accessioned | 2019-12-10T10:49:52Z | |
dc.date.available | 2019-12-10T10:49:52Z | |
dc.date.issued | 2016 | |
dc.identifier.issn | 1046-6673 | |
dc.identifier.uri | https://doi.org/10.1681/ASN.2014090947 | |
dc.identifier.uri | http://hdl.handle.net/11655/14275 | |
dc.description.abstract | Angiotensin-converting enzyme inhibitors (ACEi) for renin-angiotensin-aldosterone system (RAAS) blockade are routinely used to slow CKD progression. However, vitamin D may also promote renoprotection by suppressing renin transcription through cross-talk between RAAS and vitamin D-fibroblast growth factor-23 (FGF-23)-Klotho pathways. To determine whether vitamin D levels influence proteinuria and CKD progression in children, we performed a post hoc analysis of the Effect of Strict Blood Pressure Control and ACE Inhibition on Progression of CKD in Pediatric Patients (ESCAPE) cohort. In 167 children (median eGFR 51 ml/min per 1.73 m(2)), serum 25-hydroxyvitamin D (25(OH)D), FGF-23, and Klotho levels were measured at baseline and after a median 8 months on ACEi. Children with lower 25(OH)D levels had higher urinary protein/creatinine ratios at baseline (P=0.03) and at follow-up (P=0.006). Levels of 25(OH)D and serum vitamin D-binding protein were not associated, but 25(OH)D <= 50 nmol/L associated with higher diastolic BP (P=0.004). ACEi therapy also associated with increased Klotho levels (P<0.001). The annualized loss of eGFR was inversely associated with baseline 25(OH)D level (P<0.001, r=0.32). Five-year renal survival was 75% in patients with baseline 25(OH)D >= 50 nmol/L and 50% in those with lower 25(OH) D levels (P<0.001). This renoprotective effect remained significant but attenuated with ACEi therapy (P=0.05). Renal survival increased 8.2% per 10 nmol/L increase in 25(OH)D (P=0.03), independent of eGFR; proteinuria, BP, and FGF-23 levels; and underlying renal diagnosis. In children with CKD, 25(OH)D >= 50 nmol/L was associated with greater preservation of renal function. This effect was present but attenuated with concomitant ACEi therapy. | |
dc.language.iso | en | |
dc.publisher | Amer Soc Nephrology | |
dc.relation.isversionof | 10.1681/ASN.2014090947 | |
dc.rights | info:eu-repo/semantics/openAccess | |
dc.subject | Urology & Nephrology | |
dc.title | Normal 25-Hydroxyvitamin D Levels Are Associated With Less Proteinuria And Attenuate Renal Failure Progression In Children With Ckd | |
dc.type | info:eu-repo/semantics/article | |
dc.relation.journal | Journal Of The American Society Of Nephrology | |
dc.contributor.department | Çocuk Sağlığı ve Hastalıkları | |
dc.identifier.volume | 27 | |
dc.identifier.issue | 1 | |
dc.identifier.startpage | 314 | |
dc.identifier.endpage | 322 | |
dc.description.index | WoS | |
dc.description.index | Scopus | |