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Malik MZ, Latiwesh OB, Nouh F, Hussain A, Kumar S, Kaler J. Response of Parathyroid Hormone to Vitamin D Deficiency in Otherwise Healthy Individuals. Cureus 2020; 12:e9764. [PMID: 32821633 PMCID: PMC7430694 DOI: 10.7759/cureus.9764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objectives Vitamin D deficiency is a global public health issue, which affects people of all ages and ethnicities. However, severe deficiency seems to be more prevalent in the Middle East and South Asia. Evidence suggests that low serum 25-hydroxycholicalciferol [25(OH)D] levels are associated with an increase in parathyroid hormone (PTH). Yet, the 25-OHD levels leading to serum PTH increase are still a matter of debate. The objective of this study is to assess deficiency of vitamin D in otherwise healthy individuals, and to determine the response of the PTH to vitamin D deficiency. Methods This observational study was conducted from January 2018 to May 2018. A total of 43 individuals were selected from three separate clinics in Libya (Alrazy clinic, Alhaya clinic, and Alnukbah clinic). Blood drawn from these individuals was assessed for serum calcium, phosphorus, 25(OH)D, and PTH. These data were collected and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows (SPSS Inc., Chicago, IL). Results The mean age and standard (SD) of the study participants was 47.4 ± 12.4. The age range was 19-67 years. The ratio of male to female was 1:2. The percentage of individuals with vitamin D deficiency in the study group was 95.3%, whereas the percentage of vitamin D insufficiency was 4.7%. These data suggest that individuals with severe deficiency show higher PTH values (75.66 ng/ml), whereas those with insufficiency showed lower PTH values (37.5 ng/ml). Conclusion The population in the present study was overall deficient in 25-OH vitamin D, which indicates a greater need for supplementation with vitamin D. However, not all the individuals with vitamin D deficiency have high levels of PTH, a finding that agrees with the need for new criteria in the management of vitamin D deficiency and the importance of PTH testing.
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Affiliation(s)
- Mayra Z Malik
- Internal Medicine, Combined Military Hospital Lahore Medical College and Institute of Dentistry, New York, USA
| | - Omar B Latiwesh
- Pathology, Higher Institute of Medical Professions, Benghazi, LBY.,Biochemistry, Higher Institute of Medical Professions, Benghazi, LBY
| | - Fatimah Nouh
- Biochemistry, Faculty of Medicine, University of Benghazi, Benghazi, LBY
| | - Azhar Hussain
- Healthcare Administration, Franklin University, Columbus, USA.,Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Sohail Kumar
- Internal Medicine, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Jasndeep Kaler
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
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Farnaghi F, Hassanian-Moghaddam H, Zamani N, Gholami N, Gachkar L, Hosseini Yazdi M. Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran. BMC Pediatr 2020; 20:350. [PMID: 32684163 PMCID: PMC7370494 DOI: 10.1186/s12887-020-02240-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Vitamin D is an essential element for body health with its supplements generally administered to prevent vitamin D deficiency. Since these supplements are available in domestic settings, vitamin D toxicity may happen in children. Methods All children younger than 12 years who presented to the pediatric emergency department of Loghman Hakim Hospital, Tehran, Iran with history of ingestion of more than 1500 IU/day of vitamin D supplements were enrolled. Patients’ demographic data, on-presentation signs and symptoms, laboratory findings, treatments given, and outcome were evaluated. Result Fifteen patients presented during the study period. Their mean age was 46.53 ± 10.14 months and 12 (80%) were girls. All of them had unintentionally ingested vitamin D. Mean ingested dose was 406700.7 ± 227400.1 IU. In eight patients (53.3%), 25 hydroxy vitamin D level was more than 100 ng/mL. One patient experienced hypercalcemia while all of them were asymptomatic and discharged without complications. There was no significant difference between patients with and without high levels of 25 OH vitamin D regarding lab tests, toxicity course, and outcome. Conclusions It seems that acute vitamin D toxicity is a benign condition in our pediatric population which may be due to high prevalence of vitamin D deficiency in Iran.
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Affiliation(s)
- Fariba Farnaghi
- Departments of pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Kargar St, Makhsos St,, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Gholami
- Departments of pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Kargar St, Makhsos St,, Tehran, Iran.
| | - Latif Gachkar
- Infectious and Tropical Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hussain A, Latiwesh OB, Ali A, Tabrez E, Mehra L, Nwachukwu F. Parathyroid Gland Response to Vitamin D Deficiency in Type 2 Diabetes Mellitus: An Observational Study. Cureus 2018; 10:e3656. [PMID: 30723655 PMCID: PMC6351110 DOI: 10.7759/cureus.3656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Studies have linked vitamin D deficiency with the risk of type 2 diabetes mellitus (T2DM) and to the development of chronic complication of diabetes. Vitamin D receptors (VDR) have been found in many tissues in the body including the pancreas, a finding that indicates its role in insulin secretion. In addition, many studies have demonstrated the role of vitamin D and its receptor in insulin sensitivity and signal transduction. Vitamin D deficiency is common throughout the world, but not all vitamin D deficiencies are accompanied by a rise in parathyroid hormone (PTH). The present study was conducted to assess vitamin D deficiency in type 2 diabetic patients in comparison to healthy control and to determine parathyroid gland response to vitamin D deficiency in both groups. Methods This observational study was performed during a period from January to October 2018. The study included 151 type 2 diabetic patients selected from three diabetes clinics and 43 age and sex-matched healthy subjects. Informed consent and clinical information were obtained from all participants before the study. Results of the laboratory analysis for serum 25-hydroxyvitamin D (25-OHD), PTH, calcium, and phosphorous were recorded. The data was analyzed using the statistical package for the social sciences (SPSS) Statistics 17. Results The results showed low vitamin D concentration in both groups; however, there was no significant difference in vitamin D concentration between diabetic patients and the control patients. A high percentage of PTH level was found in severe vitamin D deficient diabetic patients and healthy controls. The higher percentage of diabetic and normal subjects with mild vitamin D deficiency had a normal PTH level. All healthy subjects with vitamin D insufficiency showed normal PTH concentration. About 10% of diabetic patients with severe vitamin D deficiency had a low PTH level. Conclusion The population in our study was generally deficient in 25-OHD irrespective of diabetes mellitus, indicating a greater need for vitamin D supplementation. Not all vitamin D deficient patients have high PTH levels, a finding that supports the emergence of new criteria for vitamin D deficiency, diagnosis and treatment, and highlights the importance of testing PTH in this regard.
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Affiliation(s)
- Azhar Hussain
- Epidemiology and Public Health, Xavier University School of Medicine, Oranjestad, ABW
| | - Omar B Latiwesh
- Pathology, Higher Institute of Medical Professions, Benghazi, LBY
| | - Alia Ali
- Internal Medicine, Sheikh Zayed Hospital, Lahore, PAK
| | - Elsa Tabrez
- Internal Medicine, American University of Integrative Sciences, Bridgetown, BRB
| | - Lalit Mehra
- Anatomy and Histology, Xavier University School of Medicine, Oranjestad, ABW
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Brown RB, Haq A, Stanford CF, Razzaque MS. Vitamin D, phosphate, and vasculotoxicity. Can J Physiol Pharmacol 2015; 93:1077-82. [DOI: 10.1139/cjpp-2015-0083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Vascular calcification is a complex process that results in the ectopic deposition of calcium-phosphate hydroxyapatite. Medial and intimal vascular calcification is frequently present in patients with diabetes mellitus and chronic kidney disease (CKD), and markedly increases the morbidity and mortality of these patients. Increased serum levels of calcium and phosphate, along with the use of active vitamin D metabolites, are commonly implicated in the evolvement of vascular wall mineralization in CKD patients. Because CKD patients have lower serum levels of vitamin D, they are routinely prescribed vitamin D supplements that exert a dualistic role that is both healthful and harmful in these patients, perhaps protecting bone health, but at the expense of promoting vascular pathology. This review briefly explains how reducing the phosphate burden in CKD patients could minimize vitamin-D-associated vascular wall calcification.
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Affiliation(s)
- Ronald B. Brown
- College of Human Ecology, Kansas State University, Manhattan, KS 66506, USA
| | - Afrozul Haq
- Division of Research & Development, VPS Healthcare, Abu Dhabi, UAE
| | | | - Mohammed S. Razzaque
- Division of Research & Development, VPS Healthcare, Abu Dhabi, UAE
- Department of Applied Oral Sciences, Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA
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Delanaye P, Bouquegneau A, Krzesinski JM, Cavalier É, Jean G, Urena-Torres P, Souberbielle JC. [Native vitamin D in dialysis patients]. Nephrol Ther 2015; 11:5-15. [PMID: 25597001 DOI: 10.1016/j.nephro.2014.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease is frequent and usually responsible of mineral and bone disorder. These abnormalities lead to increased morbidity and mortality. To become active, native vitamin D needs a first hydroxylation in the liver, and a second one in the kidney. Next to its action on bone metabolism, vitamin D also possesses pleiotropic actions on cardiovascular, immune and neurological systems as well as antineoplastic activities. End-stage renal disease (ESRD) is also associated with a decrease in vitamin D activity by mechanisms including the increase of plasma phosphate concentration, secretion of FGF-23 and decrease in 1α-hydroxylase activity. The prevalence of 25 hydroxy-vitamin D deficiency depends on the chosen cut-off value to define this lack. Currently it is well established that a patient has to be substituted when 25 hydroxy-vitamin D level is under 30 ng/mL. The use and monitoring of 1.25 hydroxy-vitamin D is still not recommended in routine practice. The goals of vitamin D treatment in case of ESRD are to substitute the deficiency and to prevent or treat hyperparathyroidism. Interest of native vitamin D in first intention is now well demonstrated. This review article describes the vitamin D metabolism and physiology and also the treatment for vitamin D deficiency in ESRD population.
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Affiliation(s)
- Pierre Delanaye
- Service de néphrologie-dialyse, CHU Sart-Tilman, université de Liège, 4000 Liège, Belgique.
| | - Antoine Bouquegneau
- Service de néphrologie-dialyse, CHU Sart-Tilman, université de Liège, 4000 Liège, Belgique
| | - Jean-Marie Krzesinski
- Service de néphrologie-dialyse, CHU Sart-Tilman, université de Liège, 4000 Liège, Belgique
| | - Étienne Cavalier
- Service de chimie clinique, CHU Sart-Tilman, université de Liège, 4000 Liège, Belgique
| | - Guillaume Jean
- Néphrologie et dialyse, Nephrocare Tassin-Charcot, Sainte-Foy-les-Lyon, France
| | - Pablo Urena-Torres
- Laboratoire d'explorations fonctionnelles, Inserm U845, hôpital Necker-Enfants malades, Paris, France; Service de néphrologie et dialyse, clinique du Landy, Saint-Ouen, France
| | - Jean-Claude Souberbielle
- Laboratoire d'explorations fonctionnelles, Inserm U845, hôpital Necker-Enfants malades, Paris, France
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Nygaard B, Frandsen NE, Brandi L, Rasmussen K, Oestergaard OV, Oedum L, Hoeck HC, Hansen D. Effects of high doses of cholecalciferol in normal subjects: a randomized double-blinded, placebo-controlled trial. PLoS One 2014; 9:e102965. [PMID: 25166750 PMCID: PMC4148309 DOI: 10.1371/journal.pone.0102965] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 06/20/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin D repletion with high doses of vitamin D is often recommended to patients and healthy subjects. The safety, especially concerning changes in urinary calcium excretion is of great importance. METHODS In a double-blinded, placebo-controlled study in 40 healthy volunteers, we examined the changes in mineral metabolism during supplementation with 3000 IU of oral cholecalciferol daily during 4 months. RESULTS Both 25(OH)vitamin D and 1,25(OH)2vitamin D increased significantly in the active treated group as compared to the placebo group (186% versus 14% (P<0.001) and 28% versus -8% (P<0.001)). No change was observed in urinary calcium excretion in the active group compared to the placebo group (P = 0.891). Fibroblast growth factor 23 increased significantly by 10% (P<0.018) in the active group. However, there was no difference in changes in FGF23 between treatment groups (P = 0.457). CONCLUSION High dose cholecalciferol significantly increases 25(OH)vitamin D and 1,25(OH)2vitamin D levels compared to placebo. No changes in urinary calcium excretion or other measured components of the mineral metabolism were found between groups. TRIAL REGISTRATION ClinicalTrials.gov NCT00952562.
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Affiliation(s)
- Birgitte Nygaard
- Department of Medicine, Roskilde University Hospital, Roskilde, Denmark
| | | | - Lisbet Brandi
- Department of Medicine, Roskilde University Hospital, Roskilde, Denmark
| | - Knud Rasmussen
- Department of Medicine, Roskilde University Hospital, Roskilde, Denmark
| | | | - Lars Oedum
- Department of Clinical Biochemistry, Roskilde University Hospital, Roskilde, Denmark
| | | | - Ditte Hansen
- Department of Medicine, Roskilde University Hospital, Roskilde, Denmark
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Metzger M, Houillier P, Gauci C, Haymann JP, Flamant M, Thervet E, Boffa JJ, Vrtovsnik F, Froissart M, Stengel B, Ureña-Torres P. Relation between circulating levels of 25(OH) vitamin D and parathyroid hormone in chronic kidney disease: quest for a threshold. J Clin Endocrinol Metab 2013; 98:2922-8. [PMID: 23633202 DOI: 10.1210/jc.2013-1294] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT Vitamin D deficiency is common in patients with chronic kidney disease (CKD). Current guidelines recommend treatment strategies in these patients similar to those for the general population, but the vitamin D nutritional status sufficient to prevent PTH levels from increasing in CKD is unknown. OBJECTIVE, MAIN OUTCOME MEASURE: Our aim was to study the relation between circulating PTH and 25(OH)D levels and to search for a 25(OH)D threshold associated with a significant PTH increase. DESIGN, SETTING, AND PATIENTS In the hospital-referred NephroTest cohort study, we measured 25(OH)D, PTH, and glomerular filtration rate (mGFR) by ⁵¹Cr-EDTA renal clearance in 929 adult patients with nondialysis CKD stages 1 to 5 and no vitamin D supplementation. Patients' mean age was 60.1 ± 14.7 years; 71% were men, and 9% were black. Their median mGFR was 37.8 mL/min/1.73 m². RESULTS We found a 25(OH)D threshold of 8 ng/mL with an upper limit of 20 ng/mL (95% confidence interval) by linear piecewise regression modeling of log-PTH for 25(OH)D adjusted for mGFR, age, race, and ionized calcium level. The smoothed curve confirmed that PTH concentration rose steeply when circulating 25(OH)D levels fell to less than 20 ng/mL. CONCLUSIONS Spontaneous 25(OH)D levels greater than 20 ng/mL seem sufficient to control serum PTH in CKD patients. This result reinforces guidelines to supplement vitamin D only if less than 30 ng/mL.
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Affiliation(s)
- Marie Metzger
- Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health, CESP, U1018, Diabetes, Obesity, and Chronic Kidney Disease Epidemiology Team, 94807 Villejuif, France.
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Silverberg DS, Schwartz D. The Role of Iron, Omega-3 Fatty Acids, and Vitamins in Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:328-41. [DOI: 10.1007/s11936-012-0188-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ring T. Vitamin D and nephrology. Nephrol Dial Transplant 2012; 27:1686; author reply 1686-7. [DOI: 10.1093/ndt/gfr787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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