Vitamin D Status and Kidney Function Decline in HIV-Infected Men: A Longitudinal Study in the Multicenter AIDS Cohort Study

Abstract

Vitamin D may play an important role in a range of disease processes. In the general population, lower vitamin D levels have been associated with kidney dysfunction. HIV-infected populations have a higher risk of chronic kidney disease. Few studies have examined the link between lower vitamin D levels and kidney function decline among HIV-infected persons. We investigated the associations of serum 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)D] with kidney function decline in a cohort of HIV-infected white and black men under highly active antiretroviral therapy treatment in the vitamin D ancillary study of the Multicenter AIDS Cohort Study. The associations of 25(OH)D and 1,25(OH)D with annual change in estimated glomerular filtration rate (eGFR) were evaluated using linear mixed effects models. This study included 187 whites and 86 blacks with vitamin D measures and eGFR ≥60 ml/min/1.73 m at baseline. Over a median follow-up of 8.0 years, lower 25(OH)D levels were significantly associated with faster eGFR decline in whites (adjusted annual change in eGFR, tertile 1: -2.06 ml/min/1.73 m vs. tertile 3: -1.23 ml/min/1.73 m, p trend .03), while no significant association was detected in blacks. Lower 1,25(OH)D was associated with faster kidney function decline in both whites and blacks, although the estimates were not statistically significant. In conclusion, lower 25(OH)D levels were significantly associated with faster eGFR decline in a cohort of HIV-infected white men, but not in those with black ancestry. Further research is warranted to investigate the association of 25(OH)D and 1,25(OH)D with kidney function decline in larger and ethnically diverse populations.

Vitamin D deficiency and kidney hyperfiltration: a mechanism of kidney injury?

“…Interestingly, as in the Mendelian randomization study by Teumer et al, there was an inverse relationship found between 25(OH)D levels and eGFR; the higher the 25(OH)D levels, the lower the eGFR. This is in contrast to other longitudinal studies where low 25(OH)D levels at one time point are associated with a faster decline in eGFR (9,18).…”

“…Ravani et al showed that serum 25(OH)D was an independent inverse predictor of kidney disease progression and death in 168 patients with early stages of CKD (8). In a cohort of men with HIV infection, lower 25(OH)D levels were associated with a faster decline in eGFR (18). Randomized clinical trials and a meta-analysis have shown that treatment with vitamin D analogs may decrease proteinuria in diabetic nephropathy and other proteinuric diseases (19,20).…”

Vitamin D as Modulator of Drug Concentrations: A Study on Two Italian Cohorts of People Living with HIV Administered with Efavirenz

“…In HIV-positive patients, reduced vitamin D concentrations were often found at various levels of severity and have been linked to low bone-mineral density and related disorders, subclinical vascular disease, kidney function decline, endocrine disorders, liver fibrosis, preterm delivery and neurocognitive impairment [7][8][9][10][11][12].…”

Low vitamin D and kidney function decline among HIV-infected adults in Thailand

“…However, younger black Americans who have higher eGFR than white American in their cohort did not prove this association. Regarding serum 1, 25 (OH) 2 D, both showed with rapid decline of eGFR but not statistically significant 7 .Their findings were also contradictory to the fact of faster eGFR decline among racial difference of black individuals 5,6 . Their findings might be due to the distribution of age and eGFR across their cohort 7,20 .…”

“…[4][5][6] However, for HIV population, it had been proved only in few western cohorts with several limitations in the context. 6,7 Then, more new studies are required for HIV populations of different regions world-wide to prove this finding universally.…”