Original article
Serum 25-hydroxyvitamin D level is negatively associated with serum phosphorus level among stage 3a-5 chronic kidney disease patients
El nivel de 25-hidroxivitamina D sérica está asociado negativamente con el nivel de fósforo sérico en pacientes con enfermedad renal crónica en estadio 3a-5
Ahmed Fayeda, Mahmoud M. El Nokeetya, Ahmed A. Heikalb, Khaled Marzouka, Hany Hammada, Dina O. Abdulazimc, Mona M. Salemd, Usama A. Sharaf El Dina,
, on behalf of the Vascular Calcification Group (VCG)
Corresponding author
a Nephrology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
b Internal Medicine Department, School of Medicine, Cairo University, Egypt
c Rheumatology and Rehabilitation Department, School of Medicine, Cairo University, Egypt
d Endocrinology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
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"apellidos" => "Sharaf El Din" ] 8 => array:1 [ "colaborador" => "on behalf of the Vascular Calcification Group (VCG)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251418301172" "doi" => "10.1016/j.nefroe.2018.02.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301172?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518300663?idApp=UINPBA000064" "url" => "/02116995/0000003800000005/v1_201810110611/S0211699518300663/v1_201810110611/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251418301160" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2018.02.014" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "484" "copyright" => "Sociedad Española de Nefrología" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2018;38:520-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1308 "formatos" => array:3 [ "EPUB" => 169 "HTML" => 736 "PDF" => 403 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Risk of hospitalization associated with body mass index and weight changes among prevalent haemodialysis patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "520" "paginaFinal" => "527" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Riesgo de hospitalización asociado con el índice de masa corporal y los cambios de peso entre los pacientes de hemodiálisis prevalentes" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1263 "Ancho" => 1583 "Tamanyo" => 64217 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Associations between baseline body mass index (BMI) and annual hospitalization rates, expressed as incidence rate ratios, in 6296 haemodialysis patients from COSMOS. Normo weight individuals were taken as the reference. Model 1 includes multivariate adjustment for age, sex, smoking (never, former or current), country, type of centre (public or private), dialysis vintage, haemodialysis hours per week and modality; Model 2 includes multivariate adjustment of variables included in model 1 plus primary kidney disease, diabetes mellitus and history of cardiovascular disease.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan J. Carrero, Ivan Cabezas-Rodríguez, Abdul R. Qureshi, Jürgen Floege, Markus Ketteler, Gerard London, Francesco Locatelli, Dimitrios Memmos, David Goldsmith, Aníbal Ferreira, Judit Nagy, Vladimir Teplan, Carlos Martínez-Salgado, José L. Fernández-Martín, Carmine Zoccali, Jorge B. Cannata-Andia" "autores" => array:17 [ 0 => array:2 [ "nombre" => "Juan J." "apellidos" => "Carrero" ] 1 => array:2 [ "nombre" => "Ivan" "apellidos" => "Cabezas-Rodríguez" ] 2 => array:2 [ "nombre" => "Abdul R." 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"apellidos" => "Cannata-Andia" ] 16 => array:1 [ "colaborador" => "on behalf of the COSMOS group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0211699518300614" "doi" => "10.1016/j.nefro.2018.02.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518300614?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301160?idApp=UINPBA000064" "url" => "/20132514/0000003800000005/v1_201811140611/S2013251418301160/v1_201811140611/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2013251418301184" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2018.03.012" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "489" "copyright" => "Sociedad Española de Nefrología" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2018;38:503-13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1724 "formatos" => array:3 [ "EPUB" => 174 "HTML" => 1054 "PDF" => 496 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Usefulness of the KDPI in Spain: A comparison with donor age and definition of standard/expanded criteria donor" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "503" "paginaFinal" => "513" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del índice KDPI en España: una comparación con la edad del donante y la definición de donante con criterios de selección estándar/ampliados" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3219 "Ancho" => 2505 "Tamanyo" => 635714 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Variables affecting graft loss in multivariate analyses. Different models were calculated including donor age as a continuous variable, donor age above 60 years, expanded criteria donor definition, KDPI (continuous variable) or different cut-off levels for KDPI.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Arias-Cabrales, María José Pérez-Sáez, Dolores Redondo-Pachón, Anna Buxeda, Carla Burballa, Sheila Bermejo, Adriana Sierra, Marisa Mir, Andrea Burón, Ana Zapatero, Marta Crespo, Julio Pascual" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Arias-Cabrales" ] 1 => array:2 [ "nombre" => "María José" "apellidos" => "Pérez-Sáez" ] 2 => array:2 [ "nombre" => "Dolores" "apellidos" => "Redondo-Pachón" ] 3 => array:2 [ "nombre" => "Anna" "apellidos" => "Buxeda" ] 4 => array:2 [ "nombre" => "Carla" "apellidos" => "Burballa" ] 5 => array:2 [ "nombre" => "Sheila" "apellidos" => "Bermejo" ] 6 => array:2 [ "nombre" => "Adriana" "apellidos" => "Sierra" ] 7 => array:2 [ "nombre" => "Marisa" "apellidos" => "Mir" ] 8 => array:2 [ "nombre" => "Andrea" "apellidos" => "Burón" ] 9 => array:2 [ "nombre" => "Ana" "apellidos" => "Zapatero" ] 10 => array:2 [ "nombre" => "Marta" "apellidos" => "Crespo" ] 11 => array:2 [ "nombre" => "Julio" "apellidos" => "Pascual" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0211699518300675" "doi" => "10.1016/j.nefro.2018.03.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518300675?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301184?idApp=UINPBA000064" "url" => "/20132514/0000003800000005/v1_201811140611/S2013251418301184/v1_201811140611/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Serum 25-hydroxyvitamin D level is negatively associated with serum phosphorus level among stage 3a-5 chronic kidney disease patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "519" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ahmed Fayed, Mahmoud M. El Nokeety, Ahmed A. Heikal, Khaled Marzouk, Hany Hammad, Dina O. Abdulazim, Mona M. Salem, Usama A. Sharaf El Din" "autores" => array:9 [ 0 => array:3 [ "nombre" => "Ahmed" "apellidos" => "Fayed" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Mahmoud M." "apellidos" => "El Nokeety" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ahmed A." "apellidos" => "Heikal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Khaled" "apellidos" => "Marzouk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Hany" "apellidos" => "Hammad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Dina O." "apellidos" => "Abdulazim" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Mona M." "apellidos" => "Salem" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 7 => array:4 [ "nombre" => "Usama A." "apellidos" => "Sharaf El Din" "email" => array:1 [ 0 => "usamaaas@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 8 => array:1 [ "colaborador" => "on behalf of the Vascular Calcification Group (VCG)" ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Nephrology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Internal Medicine Department, School of Medicine, Cairo University, Egypt" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Rheumatology and Rehabilitation Department, School of Medicine, Cairo University, Egypt" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Endocrinology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El nivel de 25-hidroxivitamina D sérica está asociado negativamente con el nivel de fósforo sérico en pacientes con enfermedad renal crónica en estadio 3a-5" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 855 "Ancho" => 1594 "Tamanyo" => 163909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Pearson correlation between serum PTH and serum 25 hydroxy vitamin D.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vitamin D is metabolized in two steps, first to 25 hydroxyvitamin D (25(OH)D) using CYP2R1 as the most important 25-hydroxylase, then to 1,25-dihydroxyvitamin D (1,25(OH)2D) using CYP27B1 as the key 1-α hydroxylase.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> The liver is the major source of 25(OH)D production from vitamin D. It seems that CYP2R1 is the major contributor to 25(OH)D production; however, other unknown enzymes are contributing to this hydroxylation and to 25(OH)D circulating levels.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> In general, the regulation of vitamin D 25-hydroxylation was not of major concern. Hence, the circulating levels of 25(OH)D are considered as a useful marker of vitamin D nutrition status.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> Both 25(OH)D and 1,25(OH)2 D are catabolized by CYP24A1as 24 hydroxylase.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> CYP24A1 prevents the eventual activation of 25(OH)D to 1,25(OH)2D and/or degrades the hormone 1,25(OH)2D within its target cells to terminate its biological activity.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> Serum inorganic P plays direct feedback regulatory role on 1-α hydroxylase and 24 hydroxylase activities. Low serum P directly stimulates 1-α hydroxylase and inhibits 24 hydroxylase and vice versa.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> On the other hand, low serum Ca stimulates PTH secretion that in turn stimulates 1-α hydroxylase and inhibits 24 hydroxylase.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> Progressive elevation of FGF23 is a feature of CKD.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6,7</span></a> Beside many other factors, P retention, increased Ca intake, vitamin D treatment, hyperparathyroidism, and Klotho deficiency are common causes of increased FGF23 in CKD.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> FGF23 inhibits Cyp27b1 activity and thus decreases synthesis of 1,25(OH)2D. It also stimulates CYP24A1, and thus increases catabolism of both 25(OH)D and 1,25(OH)2D. Via stimulation of CYP24A1, FGF23 can reduce serum 25(OH)D and 1,25(OH)2D levels.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10</span></a> However, when serum concentrations of 24,25-(OH)2D; a product of Cyp24a1 hydroxylation of 25(OH)D was measured in patients with CKD of variable severity, there was no support for FGF23-mediated catabolism of vitamin D metabolites in chronic kidney disease. In addition, there was no significant relationship between FGF23 and either 25(OH)D or 1,25(OH)2 in this CKD patient cohort.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The ability of the small intestine to actively absorb P is hormonally regulated and occurs from the ileum. The sodium-dependent P co-transporter type IIb (NPT IIb) is localized to the brush border of ileum.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> 1,25(OH)2 stimulates while FGF23 reduces intestinal NPT IIb transport activity.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2 previous studies, a negative correlation between serum 25(OH)D and Serum P was observed in pre-dialysis CKD patients.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">14,15</span></a> This finding is additionally supported by another study of the current authors that is not yet published. So far, there is no clear explanation for this negative association. In this study, we revised this negative association and looked for a possible correlation between serum FGF23 and 25(OH)D.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">One hundred newly diagnosed CKD patients were selected. They were 57 male and 43 female. According to KDOQI classification, 19 of these patients are in stage 3, 79 in stage 4, and 2 cases in stage 5. None of the selected cases was prescribed vitamin D or any phosphate binder before selection. Their age ranged between 18 and 46 years (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>S.D.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>27<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.47). A written consent was obtained from all patients and was followed by clinical examination and collection of a blood sample. Body mass index was calculated for every patient. Blood samples were used for estimation of eGFR, the serum level of Ca, P, PTH, 25(OH)D, and FGF23.</p><p id="par0025" class="elsevierStylePara elsevierViewall">eGFR was measured using MDRD equation.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> Intact PTH level was determined by enzyme-amplified sensitivity immunoassay (Roche Diagnostics, IN, USA). 25 (OH) vit D was assessed Using HPLC.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> Intact FGF23 was determined using a two-site (NH2-terminal/C-terminal) enzyme-linked immunosorbent assay (Immutopics, CA, USA). As recommended by the manufacturer, samples were collected in the morning after 12<span class="elsevierStyleHsp" style=""></span>h fasting. The collected samples were centrifuged, and the plasma was separated from the cells. Samples were assayed immediately or stored at −70<span class="elsevierStyleHsp" style=""></span>°C or below.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We then formed tertiles according to serum phosphorus to compare the blood levels of 25(OH)D, FGF23, and PTH within these tertiles.</p><p id="par0035" class="elsevierStylePara elsevierViewall">IBM SPSS Statistics package was used for data analysis. Data were summarized as mean and standard deviation. Comparison between subgroups was evaluated using Student's <span class="elsevierStyleItalic">t</span>-test. One-way analysis of variance (ANOVA) test is used to determine whether there are any statistically significant differences between the means of more than two independent groups. Correlations between different parameters were performed. Multivariate linear regression analysis was done looking for predictors of 25(OH)D. The predictors that are included in the model are serum P, PTH, FGF23, eGFR as well as age & BMI. The adjusted <span class="elsevierStyleItalic">R</span>-squared of the final model was 0.75.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Results are summarized in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1–4</a> and <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–4</a>. The different studied parameters are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Serum 25 (OH)D showed significant positive correlation with serum Ca and significant negative correlations with serum P and PTH (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.36, −0.41, and -0.71 respectively, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 in all, <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>). On the other hand, no significant relationship was observed between serum 25 (OH)D and age, BMI, or FGF23 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Serum P (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001), PTH (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001), and eGFR (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) were independently related to 25(OH)D in a multivariate linear regression analysis. By quantifying the relative importance of these parameters, serum P was the best predictor of 25(OH)D level (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">According to serum P, patients were arranged into tertiles to compare the blood levels of 25(OH)D, FGF23, and PTH within these tertiles. The lowest tertile of CKD patients had serum P of 4<span class="elsevierStyleHsp" style=""></span>mg/dL or less, the middle tertile had P between 4 and 4.8<span class="elsevierStyleHsp" style=""></span>mg/dL while the highest had P of 4.9 and more. The mean log serum level of 25 (OH)D<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>S.D. in these 3 tertiles was 1.31<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.14, 1.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.19, and 1.04<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.13 respectively, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001. Similarly, serum PTH was significantly different. On the other hand, there was no significant difference in serum FGF23 in between the three tertiles, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.488 (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> and <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Being a substrate for 1,25(OH)2D, the correlation between serum 25(OH)D and serum P should have been a positive one. 1,25(OH)2D is a strong stimulant of intestinal NPTIIb activity and thus enhances intestinal phosphate absorption. In CKD patients with impaired renal phosphate excretion, both 25(OH)D and 1,25(OH) should have a positive association with serum phosphorus. The negative association observed in previous unpublished and published studies (14,15) and confirmed in the current study raises many possible explanations. The increased FGF23 level induced by increased serum P might inhibit 25 hydroxylase or stimulate 24 hydroxylase. FGF23 was found to negatively correlate with serum 25(OH)D when studied in mice, but the same study failed to find a similar relation in human CKD patients.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> In the current study, FGF23 failed to correlate with 25(OH)D. The second possible explanation is through stimulation of PTH. Serum P can directly stimulate PTH synthesis and secretion in CKD.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> PTH is positively correlated with P in the current study. Meanwhile, PTH consistently has a negative correlation with 25(OH)D in different studies including the current study. However, this negative association is, most probably, due to the negative feedback inhibition of parathyroid by the active 1,25(OH)2D. Meanwhile, PTH is known to stimulate Cyp27b1 responsible for 1-α hydroxylase and inhibits Cyp24a1 responsible for 24 hydroxylase activity.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> These facts make suppression of 25(OH)D by PTH unlikely. The 3rd possible explanation is the impact of deteriorating kidney function on 25(OH)D. Serum 25(OH)D is significantly lower in patients with a severe decrease in eGFR compared with those with normal kidney function.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> However, the current study beside other studies denied an impact of eGFR on 25(OH)D.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20–22</span></a> The 4th and most likely possibility is a direct effect of P on 25(OH)D. Serum P directly inhibits Cyp27b1 1-α hydroxylase.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> No similar effect on CYP2R1 25 hydroxylase is encountered in the literature. On the other hand, serum P correlates with 24 hydroxylase RNA.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> This relation means that high serum P can decrease serum level of 25(OH)D through its increased catabolism by the excessive activation of Cyp24a1 24 hydroxylase. In favor of this hypothesis, Kim et al., observed a lower response to vitamin D supplementation in patients having lower baseline serum levels of 25(OH)D.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The negative association between serum 25(OH)D and SUA might be related to the recently disclosed inhibitory action of PTH on the intestinal uric acid transporter ABCG2.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> The consequent inhibition of intestinal uric acid excretion results in its retention.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Finally, this study casts doubt on the diagnostic value of serum level of 25(OH)D in the assessment of vitamin D status of pre-dialysis CKD patients. Further studies are needed before confirming this conclusion. Till such studies are available, excess administration of vitamin D2 and/or D3, especially in CKD patients, should be used cautiously.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitations of the current study</span><p id="par0065" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0070" class="elsevierStylePara elsevierViewall">This study is an uncontrolled observational cross-sectional study. The results of such studies might carry biases that are difficult to detect or correct.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0075" class="elsevierStylePara elsevierViewall">The lack of a significant association between FGF23 and serum 25 (OH) vit D in this cross-sectional study cannot completely exclude a possible inhibitory effect that necessitates longitudinal studies to detect.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0080" class="elsevierStylePara elsevierViewall">Linear regression analysis might have its limitations.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0085" class="elsevierStylePara elsevierViewall">We did not use ionized calcium instead of serum calcium. This might pause limitations especially if patients are hypoalbuminemic. However, this is not the case in this group of patients.</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Human and animal rights</span><p id="par0090" class="elsevierStylePara elsevierViewall">All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical committee approval</span><p id="par0095" class="elsevierStylePara elsevierViewall">The local ethical committee of the Internal Medicine department, School of Medicine, Cairo University, approved this work.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all individual participants included in the study.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have declared that no conflict of interests exists.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1106893" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Cases and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1046351" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1106894" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Casos y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1046352" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Limitations of the current study" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Human and animal rights" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Ethical committee approval" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Informed consent" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interests" ] 13 => array:2 [ "identificador" => "xack375809" "titulo" => "Acknowledgments" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-20" "fechaAceptado" => "2018-02-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1046351" "palabras" => array:5 [ 0 => "25-Hydroxyvitamin D" 1 => "CKD-MBD" 2 => "Phosphorus" 3 => "FGF23" 4 => "Parathyroid hormone" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1046352" "palabras" => array:5 [ 0 => "25-Hidroxivitamina D" 1 => "ERC-TMO" 2 => "Fósforo" 3 => "FGF23" 4 => "Hormona paratiroidea" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Serum 25-hydroxyvitamin D (25(OH)D) negatively correlates with serum phosphorus level of stage 3a-5 chronic kidney disease (CKD) patients. So far, no explanation has been provided for this negative association.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To confirm this negative association and determine if this relationship is mediated through other known co-morbid factors.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Cases and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">One hundred (57 male and 43 female) pre-dialysis stage 3a-5 CKD patients were selected. Estimated glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), 25(OH)D, parathyroid hormone (PTH), and intact fibroblast growth factor-23 (FGF23) were assessed. A correlation analysis between serum 25(OH)D and the different parameters studied was performed. Multivariate linear regression analysis was carried out to determine predictors of 25(OH)D.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The negative association between serum 25(OH)D and serum P was confirmed in univariate and multivariate correlation analysis. On the other hand, we failed to detect a significant association between 25(OH)D and serum FGF23. Serum P is the most important independent predictor of 25(OH)D in these patients (partial <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.15, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Serum P is likely to have a direct negative impact on serum 25(OH)D. Further studies are needed to determine the underlying mechanism.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Cases and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La 25-hidroxivitamina D (25[OH]D) sérica se correlaciona negativamente con el nivel de fósforo sérico en pacientes con enfermedad renal crónica (ERC) en estadio 3a-5. Hasta la fecha, no se dispone de ninguna explicación sobre esta asociación negativa.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Confirmar la asociación negativa y averiguar si esta relación está mediada por otros factores de comorbilidad conocidos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Casos y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron 100 pacientes (57 varones y 43 mujeres) con ERC en estadio 3a-5 prediálisis. Se evaluaron la tasa de filtración glomerular estimada (TFRe), el calcio sérico (Ca), el fósforo (P), la 25(OH)D, la hormona paratiroidea (HPT) y el factor de crecimiento de fibroblastos 23 intacto (FGF23). Se realizó un análisis de correlación entre la 25(OH)D sérica y los distintos parámetros estudiados. Se llevó a cabo un análisis de regresión lineal multivariable para determinar los factores pronósticos de 25(OH)D.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se confirmó la asociación negativa entre la 25(OH)D sérica y el P sérico en análisis de correlación univariable y multivariable. Por otro lado, no detectamos ninguna asociación significativa entre la 25(OH)D y el FGF23 sérico. El P sérico es el factor predictivo independiente más importante de la 25(OH)D en estos pacientes (R<span class="elsevierStyleSup">2</span> parcial<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,15; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001).</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Es probable que el P sérico tenga un impacto negativo directo sobre la 25(OH)D sérica. Es necesario realizar más estudios para averiguar el mecanismo subyacente.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Casos y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 853 "Ancho" => 1556 "Tamanyo" => 160873 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pearson correlation between serum calcium and serum 25 hydroxy vitamin D.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 842 "Ancho" => 1586 "Tamanyo" => 127210 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pearson correlation between serum phosphorus and serum 25 hydroxy vitamin D.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 855 "Ancho" => 1594 "Tamanyo" => 163909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Pearson correlation between serum PTH and serum 25 hydroxy vitamin D.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 943 "Ancho" => 1569 "Tamanyo" => 68374 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Log. of serum level of 25 hydroxy vit D, FGF23, and PTH according to serum phosphorus level.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CKD group (100)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean (S.D.) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18–46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (7.47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass index (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.5–28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.5 (2.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR (mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3–45.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.6 (5.98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum calcium (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5–8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.2 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum phosphorus (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4–5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 (0.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum parathormone (pg/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.3–98.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.9 (15.27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum 25 hydroxyvitamin D (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.7–32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (5.63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum FGF23 (pg/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">187–287 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">235 (22.96) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1894056.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Different studied parameters.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Significant correlations in italic font. Two tailed probability (<span class="elsevierStyleItalic">p</span>) <0.05 if correlation coefficient (<span class="elsevierStyleItalic">r</span>) ≥0.197 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 if <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>0.33; BMI: body mass index; eGFR: estimated glomerular filtration rate; Ca: calcium; P: phosphorus; PTH: parathyroid hormone; 25OHD: 25 hydroxyvitamin D; FGF23: fibroblast growth factor 23; ACR: urine albumin/creatinine ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BMI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">eGFR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">S.Ca \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">S.P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PTH \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">25OHD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">FGF23 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ACR \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.22</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.22</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S.Ca \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.74</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.26</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">0.36</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S.P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.74</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">0.26</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.41</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.26</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">0.26</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.71</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25OHD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">0.36</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.41</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−<span class="elsevierStyleItalic">0.71</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FGF23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1894055.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Pearson correlations between studied parameters.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; eGFR: estimated glomerular filtration rate; PO4: serum phosphorus; PTH: parathyroid hormone.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Partial <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95% conf. interval \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.01 to 0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.07 to 0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.05 to 2.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PO4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−2.38 to −1.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.12 to −0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin/creatinine (urine) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.11 to −0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uric acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−1.79 to −1.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.15 to 2.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.06 to −0.014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1894058.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Multivariate linear regression for predictors of vitamin D level.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">ANOVA: analysis of variance; s. 25 OH vit D: serum 25 hydroxy vitamin D; s.FGF23: serum level of fibroblast growth factor-23; lowest tertile: patients having serum phosphorus of 4<span class="elsevierStyleHsp" style=""></span>mg/dL or less; middle tertile: patients having serum phosphorus above 4 and below 4.9<span class="elsevierStyleHsp" style=""></span>mg/dL; highest tertile: patients having serum phosphorus 4.9<span class="elsevierStyleHsp" style=""></span>mg/dL or more; PTH: parathyroid hormone.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Lowest tertile<br>Range<br>Median<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>S.D. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Middle tertile<br>Range<br>Median<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>S.D. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Highest tertile<br>Range<br>Median<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>S.D. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">F</span>-ratio \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Log s.25 OH vit D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1–1.43<br>1.31<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.94–1.51<br>1.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.94–1.34<br>1.04<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Log s.FGF23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.27–2.44<br>2.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.3–2.46<br>2.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.29–2.44<br>2.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.723 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.488 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Log s.PTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.65–1.99<br>1.85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.74 –1.95<br>1.88<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7–1.99<br>1.93<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00135 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1894057.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">One-way ANOVA analysis of serum 25 OH vit D and FGF23 in between the three tertiles of serum phosphorus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitamin D metabolism, mechanism of action, and clinical applications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.D. 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| 2021 November | 138 | 51 | 189 |
| 2021 October | 58 | 64 | 122 |
| 2021 September | 54 | 48 | 102 |
| 2021 August | 54 | 41 | 95 |
| 2021 July | 51 | 33 | 84 |
| 2021 June | 37 | 37 | 74 |
| 2021 May | 46 | 64 | 110 |
| 2021 April | 144 | 94 | 238 |
| 2021 March | 75 | 30 | 105 |
| 2021 February | 43 | 48 | 91 |
| 2021 January | 63 | 23 | 86 |
| 2020 December | 56 | 23 | 79 |
| 2020 November | 48 | 16 | 64 |
| 2020 October | 33 | 27 | 60 |
| 2020 September | 36 | 17 | 53 |
| 2020 August | 54 | 16 | 70 |
| 2020 July | 41 | 16 | 57 |
| 2020 June | 45 | 18 | 63 |
| 2020 May | 52 | 23 | 75 |
| 2020 April | 29 | 19 | 48 |
| 2020 March | 27 | 16 | 43 |
| 2020 February | 39 | 18 | 57 |
| 2020 January | 39 | 29 | 68 |
| 2019 December | 40 | 27 | 67 |
| 2019 November | 74 | 18 | 92 |
| 2019 October | 43 | 13 | 56 |
| 2019 September | 44 | 21 | 65 |
| 2019 August | 25 | 19 | 44 |
| 2019 July | 43 | 24 | 67 |
| 2019 June | 38 | 22 | 60 |
| 2019 May | 38 | 31 | 69 |
| 2019 April | 59 | 58 | 117 |
| 2019 March | 72 | 26 | 98 |
| 2019 February | 43 | 17 | 60 |
| 2019 January | 47 | 45 | 92 |
| 2018 December | 69 | 58 | 127 |
| 2018 November | 41 | 12 | 53 |
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