Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study
Lynda K Cameron, Lesedi Ledwaba-Chapman, Kieran Voong, Geeta Hampson, Lui G Forni, Nina Seylanova, Dominic J Harrington, Rosario Lim, Aneta Bociek, Wang Yanzhong, Marlies Ostermann
Critical Care, doi:10.1186/s13054-024-04869-4
Background Vitamin D deficiency in critically ill patients is associated with poor outcomes, and vitamin D supplementation is recommended for patients with chronic kidney disease. Whether acute kidney injury (AKI) is associated with altered Vitamin D metabolism is unknown. We aimed to compare the longitudinal profiles of serum 25(OH) D and 1,25(OH) 2 D concentrations in critically ill patients with and without moderate to severe AKI and explore the impact of renal recovery and parathyroid hormone (PTH).
Methods In this prospective, observational study in two centres in the UK, critically ill patients with and without AKI underwent serial measurement of serum 25(OH)D and 1,25(OH) 2 D and plasma PTH concentrations for 5 days. Linear mixed model analysis and sensitivity analyses were performed.
Results Serial data of 137 patients were analysed. Seventy-one patients had AKI stage II/III of whom 23 recovered kidney function during the 5-day study period; 66 patients did not have AKI at enrolment of whom 14 developed new AKI. On day of enrolment, patients' serum 25(OH)D concentrations were low (median 18 nmol/L) but there was no significant difference between patients with and without AKI. Median serum 1,25(OH) 2 D levels were significantly lower in patients with AKI II/III (41 pmol/L [IQR 26, 58]) compared to similarly unwell patients without AKI (54 pmol/L [IQR 33, 69]) during the 5-day period. Recovery of kidney function in patients with AKI was associated with a rise in 1,25(OH) 2 D concentrations. Plasma PTH results were impacted by serum calcium and magnesium levels but not associated with 1,25(OH) 2 D levels. Conclusions Critically ill patients with moderate-to-severe AKI have significantly lower serum 1,25(OH) 2 D concentrations than similarly sick patients without AKI but there was no difference in serum 25(OH)D concentrations. Recovery of AKI was associated with a rise in serum 1,25(OH) 2 D concentrations. More research is needed to investigate the health benefits and safety of supplementation with active vitamin D in critically ill patients with moderate-tosevere AKI. Trial registration Clinicaltrials.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s13054-024-04869-4.
Additional file 1.
Author contributions All authors contributed to the study conception and design. Sampling and data collection were performed by LC, RL and AB. The laboratory analyses were performed by KV and GH. DJH assisted with the laboratory analyses. The statistical analyses were done by LLC and WY. The first draft of the manuscript was written by MO. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Declarations Ethics approval and consent to participate The study was approved by a National Research Ethics Committee in the UK (London Camberwell St Giles) (IRAS 196968) and carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). Written informed consent was obtained from participants or provided by a personal or professional consultee if the patient did not have capacity to consent for themselves. In a case where a consultee had given permission for the patient to take part, the patient was invited to give informed consent to continue participation or to withdraw from further participation as soon as they regained capacity.
Consent for publication Written consent for publication was obtained from participants or provided by a personal or professional consultee if the patient did not have capacity to consent..
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'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n'
' <jats:title>Background</jats:title>\n'
' <jats:p>Vitamin D deficiency in critically ill patients is associated with '
'poor outcomes, and vitamin D supplementation is recommended for patients with chronic kidney '
'disease. Whether acute kidney injury (AKI) is associated with altered Vitamin D metabolism is '
'unknown. We aimed to compare the longitudinal profiles of serum 25(OH)D and '
'1,25(OH)<jats:sub>2</jats:sub>D concentrations in critically ill patients with and without '
'moderate to severe AKI and explore the impact of renal recovery and parathyroid hormone '
'(PTH).</jats:p>\n'
' </jats:sec><jats:sec>\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>In this prospective, observational study in two centres in the UK, '
'critically ill patients with and without AKI underwent serial measurement of serum 25(OH)D '
'and 1,25(OH)<jats:sub>2</jats:sub>D and plasma PTH concentrations for 5\xa0days. Linear mixed '
'model analysis and sensitivity analyses were performed.</jats:p>\n'
' </jats:sec><jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>Serial data of 137 patients were analysed. Seventy-one patients had '
'AKI stage II/III of whom 23 recovered kidney function during the 5-day study period; 66 '
'patients did not have AKI at enrolment of whom 14 developed new AKI. On day of enrolment, '
'patients’ serum 25(OH)D concentrations were low (median 18\xa0nmol/L) but there was no '
'significant difference between patients with and without AKI. Median serum '
'1,25(OH)<jats:sub>2</jats:sub>D levels were significantly lower in patients with AKI II/III '
'(41\xa0pmol/L [IQR 26, 58]) compared to similarly unwell patients without AKI (54\xa0pmol/L '
'[IQR 33, 69]) during the 5-day period. Recovery of kidney function in patients with AKI was '
'associated with a rise in 1,25(OH)<jats:sub>2</jats:sub>D concentrations. Plasma PTH results '
'were impacted by serum calcium and magnesium levels but not associated with '
'1,25(OH)<jats:sub>2</jats:sub>D levels.</jats:p>\n'
' </jats:sec><jats:sec>\n'
' <jats:title>Conclusions</jats:title>\n'
' <jats:p>Critically ill patients with moderate-to-severe AKI have '
'significantly lower serum 1,25(OH)<jats:sub>2</jats:sub>D concentrations than similarly sick '
'patients without AKI but there was no difference in serum 25(OH)D concentrations. Recovery of '
'AKI was associated with a rise in serum 1,25(OH)<jats:sub>2</jats:sub>D concentrations. More '
'research is needed to investigate the health benefits and safety of supplementation with '
'active vitamin D in critically ill patients with moderate-to-severe AKI.</jats:p>\n'
' <jats:p><jats:italic>Trial registration</jats:italic> Clinicaltrials.gov '
'(NCT02869919), registered on 16 May 2016.</jats:p>\n'
' </jats:sec>',
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