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array:12 [ "idiomaDefecto" => true "titulo" => "Valvular calcifications at the start of dialysis predict the onset of cardiovascular events in the course of follow-up" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "163" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las calcificaciones valvulares al inicio de diálisis predicen la aparición de eventos cardiovasculares en la evolución" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "498v35n02-90412312fig5.jpg" "Alto" => 904 "Ancho" => 2000 "Tamanyo" => 111002 ] ] "descripcion" => array:1 [ "en" => " Event-free survival (MI, stroke and/or death from cardiovascular causes); Kaplan-Meier Curves A: all patients; B: patients with no diagnosis of coronary artery disease, stroke or AF at the start of dialysis; VC: valvular calcification" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen Sánchez-Perales, Eduardo Vázquez Ruiz de Castroviejo, Mª José García-Cortés, Mª del Mar Biechy, Jose Manuel Gil-Cunquero, Josefa Borrego-Hinojosa, Pilar Pérez del Barrio, Francisco Borrego-Utiel, Antonio Liébana" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Carmen" "apellidos" => "Sánchez-Perales" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Vázquez Ruiz de Castroviejo" ] 2 => array:2 [ "nombre" => "Mª José" "apellidos" => "García-Cortés" ] 3 => array:2 [ "nombre" => "Mª del Mar" "apellidos" => "Biechy" ] 4 => array:2 [ "nombre" => "Jose Manuel" 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"formatos" => array:3 [ "EPUB" => 334 "HTML" => 5359 "PDF" => 636 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "146" "paginaFinal" => "149" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diálisis peritoneal paliativa: implantación de un programa de atención domiciliaria a enfermos tratados con diálisis peritoneal (DP) en situación terminal" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maite Rivera Gorrin, José Maite Rivera Gorrin, José Luis Teruel-Briones, Victor Burguera Vion, Lourdes Rexach, Carlos Que xTeruel-Briones, Carlos Quereda" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Maite" "apellidos" => "Rivera Gorrin" ] 1 => array:2 [ "nombre" => "José Maite Rivera Gorrin, José Luis Teruel-Briones, Victor Burguera Vion, Lourdes Rexach, Carlos Que" "apellidos" => "xTeruel-Briones" ] 2 => array:2 [ "nombre" => "Victor" "apellidos" => "Burguera Vion" ] 3 => array:2 [ "nombre" => "Lourdes" "apellidos" => "Rexach" ] 4 => array:2 [ "nombre" => "Carlos" "apellidos" => "Quereda" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251415123104?idApp=UINPBA000064" "url" => "/20132514/0000003500000002/v0_201504231604/X2013251415123104/v0_201504231605/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "The effect of some medications given to CKD patients on vitamin D levels" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "150" "paginaFinal" => "156" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Claudia Yuste, Borja Quiroga, Soledad García de Vinuesa, Maria Angeles Goicoechea, Daniel Barraca, Ursula Verdalles, Jose Luño" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Claudia" "apellidos" => "Yuste" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Borja" "apellidos" => "Quiroga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Soledad" "apellidos" => "García de Vinuesa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Maria Angeles" "apellidos" => "Goicoechea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Daniel" "apellidos" => "Barraca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Ursula" "apellidos" => "Verdalles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "nombre" => "Jose" "apellidos" => "Luño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Department of Nephrology. Gregorio Marañón University General Hospital. Madrid (Spain)" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectos de algunos fármacos administrados a los pacientes de ERC sobre los niveles de vitamina D" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "498v35n02-90412311fig4.jpg" "Alto" => 912 "Ancho" => 1012 "Tamanyo" => 66057 ] ] "descripcion" => array:1 [ "en" => " Relationship between therapies and baseline serum 25¿OH¿D3 levels. Patients were divided in three groups according with the concomitant therapies, and there were significant statistical differences between groups (p <0 001 patients who were not receiving renin angiotensin system ras inhibitors or allopurinol n="30)" presented lower 25 8209 oh d3 d levels than those and plus p <0 001 highest 25 8209 oh d3 levels 11 7 3 p="0.005)" were found in patients receiving ras inhibitors plus allopurinol without statins lowest 5 1 82 who only</0> </0>" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction </span></p><p class="elsevierStylePara"> Over last decade, interest in vitamin D physiopathology has increased greatly due to the discovery of additional biological actions of vitamin D out off its traditional role in bone and mineral metabolism. These additional biological effects are: suppression of renin¿angiotensin system<span class="elsevierStyleSup">1</span> (RAS), protection against cardiovascular event,<span class="elsevierStyleSup">2</span> decrease in inflammatory markers,<span class="elsevierStyleSup">3,4</span> reduction of megalin and cubilin shedding,<span class="elsevierStyleSup">5</span> improved systolic blood pressure in patients with type 2 diabetes,<span class="elsevierStyleSup">6</span> and increases nephrin expression in podocytes in experimental data.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara"> On the other hand, vitamin D deficiency is an emerging global health problem that is estimated to affect more than 1 billion people worldwide.<span class="elsevierStyleSup">8</span> It is very common in patients with chronic kidney disease (CKD), even at early stages,<span class="elsevierStyleSup">9</span> and the severity of deficiency increases with the progression of kidney disease.</p><p class="elsevierStylePara"> Vitamin D deficiency is partly caused by vitamin dysregulated D metabolism in kidney disease, because the final activation step of synthesis of Vitamin D, 1¿hydroxylation, occurs primarily, but not exclusively, in the kidney.</p><p class="elsevierStylePara"> CKD patients used to have a high comorbidity, so are treated with a huge amount of drugs.<span class="elsevierStyleSup">10,11</span> Therefore medication¿ related problems are very common in CKD patients. The possible collateral effect of these medications on vitamin D synthesis and metabolism had been previously described,<span class="elsevierStyleSup">12,13</span> but remains unclear.</p><p class="elsevierStylePara"> We conducted an observational study to assess the characteristics of 25¿OH¿D3 deficient CKD patients, including the possible role of different associated therapies, as statins, renin angiotensin system (RAS) inhibitors or Allopurinol.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Participants </span></p><p class="elsevierStylePara"> A transversal single¿center study was conducted including a sample of 137 incident patients referred to our CKD outpatient clinic. Patients undergoing renal replacement therapy, kidney transplant recipients, and with recent hospital admission in last 3 months or with acute diseases, were excluded. We also excluded patients supplemented with any kind of vitamin D or analog in the last 3 months. Medical records were consulted to obtain demographic, anthropometric data and previous cardiovascular events. Treatment was also recorded: kind and number of antihypertensive drugs, statin and allopurinol therapy. Analytical values were collected at the same time including creatinine, calcium, phosphate, parathormone (PTH), serum uric acid, ultrasensible C¿reactive protein (CRP), proteinuria and urine albumin/creatinine ratio. To avoid seasonal changes, serum 25¿OH¿D3 levels were determined in all patients between February and May.</p><p class="elsevierStylePara"> Patients were divided in three groups according RAS inhibitors or allopurinol concomitant therapies into none (n=26), RAS inhibitors or allopurinol (n=81), and RAS inhibitors plus allopurinol (n=30); with the aim to study the influence of statin therapy in these groups.</p><p class="elsevierStylePara"> Laboratory measurements were made using standardized automated methods. Daily urinary albumin excretion was measured with an immunonephelometric method. Serum 25¿OH¿D3 levels and intact PTH were measured using standarized automated methods of chemiluminescence immunoassay (Liaison<span class="elsevierStyleSup">®</span> and Immulite 2000<span class="elsevierStyleSup">®</span>, respectively).</p><p class="elsevierStylePara"> Estimated glomerular filtration rate (eGFR) was calculated using the MDRD¿4 formula.<span class="elsevierStyleSup">14</span> Vitamin D deficiency was defined according with KDOQI 2008 guidelines as 25¿OH¿D3 levels less than 15 ng/mL.<span class="elsevierStyleSup">15 </span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Statistical analysis </span></p><p class="elsevierStylePara"> Normally distributed values are expressed as mean ±SD (standard deviation); non¿normally distributed values are expressed as median ±IQR (interquartile range). The differences in quantitative variables were examined using the chi¿square test for categorical variables and t test for continuous variables. Analysis of variance was used to study the differences on 25¿OH¿D3 levels between the groups according concomitant therapies. A linear model was accomplished to identify the relationship between different variables. Multivariate analysis (linear multivariate regression) was performed to determine the independent risk factors for 25¿OH¿D3 deficiency including all the factors with p<0.1 in the univariate model and potential confounding factors (as concomitant therapies, age, gender, diabetes mellitus, eGFR, and prior history of congestive cardiac failure). All statistical analyses were conducted using SPSS for Windows, V 11 (SPSS<span class="elsevierStyleSup">®</span>, Chicago, Illinois, USA). Statistical significance was set at P<0.05.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results </span></p><p class="elsevierStylePara"> Demographic data, clinical and baseline biochemical characteristics are shown in Table 1. Mean serum 25¿OH¿D3 levels were 8.23±4.03 ng/ml. According with KDOQUI guidelines<span class="elsevierStyleSup">16</span> 86 patients (62.7%) had CKD stage 3, 10.2% stages 1 and 2, and 27% presented eGFR<30 ml/min/1.73 m<span class="elsevierStyleSup">2</span>. Although male gender presented higher 25¿OH¿D3 levels (8.35 [±3.40] versus 7.52 [±3.06] ng/dl) these differences are not significant. Sixty¿one patients (33.2%) had a previous cardiovascular event (CVE). The most frequent was myocardial infarction with 14.7%. Previous congestive cardiac failure (CCF) had been found in 18 patients (9.8%).</p><p class="elsevierStylePara"><img alt="Table 1 Baseline characteristic of the patients" src="498v35n02-90412311fig1.jpg"></img></p><p class="elsevierStylePara"> Eighty¿eight patients (64.7%) were receiving 3 or more concomitant drugs. Only 7 patients (5.1%) were not receiving any treatment. Bone and mineral metabolism parameters and eGFR of the patients according concomitant medications are shown in Table 2. Patients under RAS inhibitors and allopurinol treatment were associated with higher 25¿OH¿D3 levels. However, statin treatment, diabetes mellitus and history of CCF was associated with lower levels of 25¿OH¿D3 levels. Allopur inol¿taking patients presented higher ser um phosphate and PTH levels as well as and lower eGFR. Patients treated with insulin, erythropoiesis¿stimulating agents (ESA) and with history of CVE presented lower eGFR. There are no differences between calcium levels according concomitant drugs. Multivariate analysis adjusted by age, gender, eGFR, serum calcium and PTH levels, personal history of diabetes, CVE or CCF showed that RAS inhibitors (beta 1.73, p=0.013), allopurinol treatment (beta 1.63, p=0.011) and statins treatment (beta –1.35 and p=0.029) were independent predictors for lower serum 25¿OH¿D3 levels (Table 3).</p><p class="elsevierStylePara"><img alt="Table 2 Analytical characteristic of the patients according with the therapies" src="498v35n02-90412311fig2.jpg"></img></p><p class="elsevierStylePara"><img alt="Table 3 Linear Multivariate Regression (adjusted by age, eGFR and prior history of Congestive cardiac failure)" src="498v35n02-90412311fig3.jpg"></img></p><p class="elsevierStylePara"> Patients who were not receiving RAS inhibitors or allopurinol presented lower 25¿OH¿D3 levels than those receiving RAS inhibitors or allopurinol, and RAS inhibitors plus allopurinol (p<0.001) (Fig. 1). Highest 25¿OH¿D3 levels (11.7±3.11 ng/mL) of our cohort were found in patients receiving RAS inhibitors plus allopurinol without statins. Lowest 25¿OH¿D3 levels of our cohort (5.7±1.82 ng/mL) were found in patients who receiving statins alone. In the group without RAS inhibitors or Allopurinol patients under statins therapy presented lower serum vitamin D levels (5.7±1.82 ng/mL vs. 7.8±3.4 ng/mL, p=0.05) compared with patient under RAS inhibitors or Allopurinol alone. Similarly, in the group with RAS inhibitors plus Allopurinol patients under statins therapy presented lower serum vitamin D levels (11.7±3.5 ng/mL vs. 8.5±2.5 ng/mL, p=0.003) than those with RAS inhibitors plus Allopurinol alone. There were also statistical differences when we compared patients under statin treatment with and without RAS or allopurinol therapy (5.7±1.82 ng/mL vs. 7.5±3.2 ng/mL, respectively p=0.015) and comparing patients under statin treatment with RAS or allopurinol therapy with patients under RAS plus allopurinol therapy (5.7±1.82 ng/mL vs. 8.5±2.3 ng/mL, p=0.02 respectively). Similarly, there were statistical differences comparing patients without statin treatment with RAS inhibitors or Allopurinol treatment vs. RAS inhibitors plus Allopurinol (7.8±3.4 ng/mL vs. 11.7±3.5 ng/mL, p=0.002).</p><p class="elsevierStylePara"><img alt="Figure 1 Relationship between therapies and baseline serum 25¿OH¿D3 levels. Patients were divided in three groups according with the concomitant therapies, and there were significant statistical differences between groups (p<0.001). Patients who were not receiving renin angiotensin system (RAS) inhibitors or allopurinol (n=26) presented lower 25¿OH¿D3 D levels than those receiving RAS inhibitors or allopurinol (n=81), and RAS inhibitors plus allopurinol (n=30) (p<0.001). Highest 25¿OH¿D3 levels (11.7±3.11, p=0.003) were found in patients receiving RAS inhibitors plus allopurinol without statins. Lowest 25¿OH¿D3 levels (5.7±1.82, p=0.005) were found in patients who only receiving statins." src="498v35n02-90412311fig4.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1 – Relationship between therapies and baseline serum 25¿OH¿D<span class="elsevierStyleInf">3</span> levels. Patients were divided in three groups according with the concomitant therapies, and there were significant statistical differences between groups (p<0.001). Patients who were not receiving renin angiotensin system (RAS) inhibitors or allopurinol (n=26) presented lower 25¿OH¿D<span class="elsevierStyleInf">3</span> D levels than those receiving RAS inhibitors or allopurinol (n=81), and RAS inhibitors plus allopurinol (n=30) (p<0.001). Highest 25¿OH¿D<span class="elsevierStyleInf">3</span> levels (11.7±3.11, p=0.003) were found in patients receiving RAS inhibitors plus allopurinol without statins. Lowest 25¿OH¿D<span class="elsevierStyleInf">3</span> levels (5.7±1.82, p=0.005) were found in patients who only receiving statins.</span></p><p class="elsevierStylePara"> Additionally, we collected 25¿OH¿D3 levels in 23 CKD patients before (17.8 [11.9¿26.45]) and 3 months after (22.0 [13.65¿27.45]) RAS inhibitors introduction (p<0.001), and in 15 patients before (43.3 [14.0¿76.8]) and 3 months after (25.7 [23.2¿43.3]) Allopurinol introduction (p=0.66).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion </span></p><p class="elsevierStylePara"> Our data suggest that concomitant treatment with allopurinol and RAS inhibitors is associated with high levels of 25¿OH¿D3 in CKD vitamin D deficient population. On the other hand, treatment with statins is associated with lower levels.</p><p class="elsevierStylePara"> CKD patients used to have a high comorbidity and therefore are treated with a huge amount of drugs. The possible collateral effect of these medications on vitamin D synthesis and metabolism had been previously described in some reports, but remains unclear.</p><p class="elsevierStylePara"> Although the interaction between Vitamin D and RAS is well known there are not previous reports about the effect of RAS inhibition on vitamin D levels. Vitamin D is a down regulator of the RAS by supressing renin expression,<span class="elsevierStyleSup">1,17</span> and its deficiency can activate the local RAS in the kidney.<span class="elsevierStyleSup">18</span> The renoprotective and antiatherogenic efficacy of the combination therapies of RAS inhibitors and vitamin D analogue has been reported in animal models.<span class="elsevierStyleSup">19¿21</span> To provide biological plausibility to our finding, we have 2 different arguments. Firstly, RAS inhibitors by decreasing glomerular proteinuria, decrease the competition between proteins and vitamin D for receptor¿binding site to be reabsorbed by megalin¿cubilin complex in the proximal tubule.<span class="elsevierStyleSup">22</span> That means that RAS inhibitors increase the free receptor¿binding sites for vitamin D reabsorption. And secondly, RAS inhibitors have a potent anti¿inflammatory effect<span class="elsevierStyleSup">23,24</span> and the inflammatory status has been associated in many studies with vitamin D levels.<span class="elsevierStyleSup">3¿5</span></p><p class="elsevierStylePara"> Patients treated with Allopurinol had higher 25¿OH¿D3 levels. We did not find any association with serum uric acid levels. Takahashi et al. described a lower serum 1¿25 (OH) D3 levels in gout patients compared with control subjects, and a significant increase in serum 1¿25 (OH) D3 after 1 year of administration of uric acid lowering agent. In animal models had been found that uric acid and xanthine suppresses 1alpha¿hydroxylase activity and synthesis of 1¿25 (OH) D3 and also suppresses its clearance rate.<span class="elsevierStyleSup">25</span> Moreover in the Vanholder et al. small cohort of CKD patients had been reported an increase in 1¿25 (OH) D3 after allopurinol treatment,<span class="elsevierStyleSup">26</span> which they mainly attributed to a decrease in clearance rate of 1¿25 (OH) D3. On the other hand, the anti¿inflammatory power of Allopurinol was found also in moderate CKD.<span class="elsevierStyleSup">27</span> In our opinion, the increase in 25¿OH¿D3 on allopurinol treated patients observed is due to decrease in anti¿inflammatory markers and suppression on 25¿OH¿D3 clearance rate.</p><p class="elsevierStylePara"> Vitamin D is mainly produced by the endogenous pathway. Seven¿ dehydrocholesterol is converted to vitamin D3 in the skin in response to ultraviolet B light exposure.<span class="elsevierStyleSup">28</span> Statins reduce both cholesterol and 7¿DHC production, and would be expected to reduce both cholesterol and vitamin D production. Furthermore, 25¿OH¿D3 before to be hydroxilated in the kidney, need to be reabsorbed in the proximal tubules by megalin/cubilin/amnioless complex. Megalin belongs to LDL receptor family.<span class="elsevierStyleSup">29</span> This complex must be prenylated to be active. Statins, by inhibiting HMG¿CoA reductase, reduce the amount of mevalonate, a key intermediate in these preynilation. Deficiency or dysfunction of the megalin– cubilin complex decreases vitamin D concentrations.<span class="elsevierStyleSup">30</span> However the effect of statins in vitamin D metabolism is unclear and some studies suggested that statins may increase<span class="elsevierStyleSup">10</span> or not affect30 vitamin D levels, maybe depending on their anti¿inflammatory power.</p><p class="elsevierStylePara"> We did not find any association between some of the traditional risk factors for 25¿OH¿D3 deficiency, as age, female gender, diabetes mellitus<span class="elsevierStyleSup">5</span> or proteinuria.4 Possibly because we selected a very specific cohort, CKD patients with severe deficiency of 25¿OH¿D3, what means a proteinuric elderly male dominant cohort (564.0 [±994.6] mg/g, 70.77 [±16.1] years and 53.3 respectively) with 40.4% of diabetics.</p><p class="elsevierStylePara"> Although we found an increase in 25¿OH¿D3 levels after 3 months of SRAA therapy in a small subanalysis group (n=23) reassuring our previous findings, we understand that the small sample size just allow us to highlight the possible association.</p><p class="elsevierStylePara"> There are several limitations to our study. Firstly, the small number of patients. Secondly, 25¿OH¿D3 levels could be undervalued because we only made a single determination in spring (February and May). Thirdly, we did not consider for how long the patients have been with the recorded therapy, the reason, the dose or the achievement of the therapeutic gold. Finally this is just a transversal study, therefore we only can point the associations that we found, but not the causality.</p><p class="elsevierStylePara"> In conclusion, 25¿OH¿D3 deficiency and polypharmacy are a common problem over CKD patients. Patients under RAS inhibitors or Allopurinol treatment had higher 25(OH) D levels, however patients with statins treatment had lower vitamin D level. Finally, randomized controlled trials are required to confirm these findings.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Financial support </span></p><p class="elsevierStylePara"> None.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interests </span></p><p class="elsevierStylePara"> The authors declare that they have no conflict of interests.</p><hr></hr><p class="elsevierStylePara"> * <span class="elsevierStyleItalic">Corresponding author.<br></br></span>Claudia Yuste, <br></br> Department of Nephrology, <br></br> Gregorio Marañón University General Hospital, Madrid, Spain. <br></br> Telephone number: 0034915868319. Fax number: 0034915868683.<br></br><span class="elsevierStyleItalic">E-mail:</span><a href="mailto:claudiayustelozano@yahoo.es" class="elsevierStyleCrossRefs">claudiayustelozano@yahoo.es</a></p>" "pdfFichero" => "498v35n02a90412311pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec503483" "palabras" => array:5 [ 0 => "Vitamina D" 1 => "Enfermedad renal crónica" 2 => "Alopurinol" 3 => "Estatinas" 4 => "Inhibidores RAS" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec503484" "palabras" => array:5 [ 0 => "Vitamin D" 1 => "Chronic kidney disease" 2 => "Allopurinol" 3 => "Statins" 4 => "RAS inhibitors" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"> <span class="elsevierStyleItalic">Antecedentes:</span> La deficiencia de vitamina D y la polifarmacia constituyen un problema común en la población con enfermedad renal crónica (ERC).</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Objetivos:</span> Evaluar las características clínicas y analíticas de los pacientes de ERC con deficiencia de 25¿OH¿D3 (<15 ng/mL), incluyendo la función posible de los fármacos asociados.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Métodos:</span> Se realizó una revisión observacional en un único centro, de 137 pacientes incidentes remitidos a nuestra clínica ambulatoria con diferentes estadios de ERC y 25¿OH¿D3<15 ng/mL (varones 53,3%, edad media 70,8 [±16,1] año, GFR medio (MDRD¿4) 43,6 [±25,5] ml/min/1,73 m<span class="elsevierStyleSup">2</span>). Los valores de 25¿OH¿D3 se recolectaron en primavera. Se registraron los datos bioquímicos y los fármacos asociados.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Resultados:</span> Los niveles medios de 25¿OH¿D3 fueron de 8,23 [±4,03] ng/ml. Ochenta y ocho pacientes (64,7%) tomaban tres o más fármacos concomitantes. Únicamente siete pacientes (5,1%) no recibían medicación alguna. Los pacientes fueron divididos en tres grupos, conforme a las terapias: ninguna (n = 26), inhibidores RAS o Alopurinol (n = 81), e inhibidores RAS más alopurinol (n = 30), a fin de estudiar la influencia de la terapia de estatinas. Los pacientes sometidos a tratamiento de inhibidores de la renina¿angiotensina (RAS) o Alopurinol presentaron unos niveles considerablemente superiores de 25¿OH¿D3 (p = 0,001 y p = 0,01 respectivamente), y sin embargo los pacientes con tratamiento de estatinas presentaron unos menores niveles de 25¿OH¿D3 (p = 0,039). La presencia de diabetes, episodios cardiovasculares u otras terapias no modificaron los niveles de 25¿OH¿D3, ajustados por edad y eGFR.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Conclusiones:</span> Los pacientes de ERC con deficiencia de vitamina D, sometidos a tratamiento de inhibidores RAS o Alopurinol reflejaron unos niveles superiores de 25¿OH¿D3, y sin embargo aquellos sometidos a tratamiento de estatinas reflejaron unos menores niveles de vitamina D. Se precisan ensayos aleatorizados controlados para confirmar estos hallazgos.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"> <span class="elsevierStyleItalic">Background:</span> Vitamin D deficiency and polypharmacy is a common problem over chronic kidney disease (CKD) population.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Objectives:</span> To assess the clinical and analytical characteristics of CKD patients with 25¿OH¿D3 deficiency (<15 ng/mL), including the possible role of associated drugs.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Methods:</span> A single center observational review of 137 incident patients referred to our outpatient clinic with different stages of CKD and 25¿OH¿D3<15ng/mL (male gender 53.3%, mean age 70.8 [±16.1] years, mean GFR (MDRD¿4) 43.6 [±25.5] ml/min/1.73 m<span class="elsevierStyleSup">2</span>). 25¿OH¿D3 levels were collected in spring. Clinical and biochemical data and associated medications were recorded.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Results:</span> Mean 25¿OH¿D3 levels were 8.23 [±4.03] ng/ml. Eighty¿eight patients (64.7%) had 3 or more concomitant drugs. Only 7 patients (5.1%) were not receiving any medication. Patients were divided in three groups according the therapies into none (n=26), RAS inhibitors or allopurinol (n=81), and RAS inhibitors plus allopurinol (n=30); with the aim to study the influence of statin therapy. Patients under renin angiotensin (RAS) inhibitors or Allopurinol treatment presented significantly higher 25¿OH¿D3 levels (p=0.001 and p=0.01 respectively), however patients with Statins treatment had lower 25¿OH¿D3 level (p=0.039). Personal history of diabetes, cardiovascular events or other therapies did not modify 25¿OH¿D3 levels, adjusted by age and eGFR.</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Conclusions:</span> CKD patients with vitamin D deficiency who received RAS inhibitors or Allopurinol treatment had higher 25¿OH¿D3 levels, however those with statins treatment had lower vitamin D levels. Randomized controlled trials are required to confirm these findings.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl1" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "498v35n02-90412311fig1.jpg" "imagenAlto" => 1037 "imagenAncho" => 2116 "imagenTamanyo" => 276019 ] ] ] ] ] "descripcion" => array:1 [ "en" => " Baseline characteristic of the patients" ] ] 1 => array:8 [ "identificador" => "tbl2" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "498v35n02-90412311fig2.jpg" "imagenAlto" => 1608 "imagenAncho" => 2841 "imagenTamanyo" => 657630 ] ] ] ] ] "descripcion" => array:1 [ "en" => " Analytical characteristic of the patients according with the therapies" ] ] 2 => array:8 [ "identificador" => "tbl3" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "498v35n02-90412311fig3.jpg" "imagenAlto" => 500 "imagenAncho" => 1033 "imagenTamanyo" => 89964 ] ] ] ] ] "descripcion" => array:1 [ "en" => " Linear Multivariate Regression (adjusted by age, eGFR and prior history of Congestive cardiac failure)" ] ] 3 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "498v35n02-90412311fig4.jpg" "Alto" => 912 "Ancho" => 1012 "Tamanyo" => 66057 ] ] "descripcion" => array:1 [ "en" => " Relationship between therapies and baseline serum 25¿OH¿D3 levels. Patients were divided in three groups according with the concomitant therapies, and there were significant statistical differences between groups (p <0 001 patients who were not receiving renin angiotensin system ras inhibitors or allopurinol n="30)" presented lower 25 8209 oh d3 d levels than those and plus p <0 001 highest 25 8209 oh d3 levels 11 7 3 p="0.005)" were found in patients receiving ras inhibitors plus allopurinol without statins lowest 5 1 82 who only</0> </0>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest. 2002;110:229-38." 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Original language: English
Year/Month | Html | Total | |
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2024 November | 2 | 4 | 6 |
2024 October | 40 | 28 | 68 |
2024 September | 44 | 21 | 65 |
2024 August | 76 | 42 | 118 |
2024 July | 37 | 20 | 57 |
2024 June | 53 | 27 | 80 |
2024 May | 42 | 29 | 71 |
2024 April | 50 | 21 | 71 |
2024 March | 40 | 24 | 64 |
2024 February | 22 | 33 | 55 |
2024 January | 32 | 24 | 56 |
2023 December | 27 | 24 | 51 |
2023 November | 34 | 33 | 67 |
2023 October | 40 | 61 | 101 |
2023 September | 23 | 22 | 45 |
2023 August | 26 | 28 | 54 |
2023 July | 41 | 32 | 73 |
2023 June | 30 | 20 | 50 |
2023 May | 45 | 25 | 70 |
2023 April | 26 | 10 | 36 |
2023 March | 19 | 14 | 33 |
2023 February | 29 | 12 | 41 |
2023 January | 39 | 22 | 61 |
2022 December | 44 | 28 | 72 |
2022 November | 42 | 23 | 65 |
2022 October | 31 | 27 | 58 |
2022 September | 40 | 22 | 62 |
2022 August | 56 | 38 | 94 |
2022 July | 21 | 33 | 54 |
2022 June | 43 | 30 | 73 |
2022 May | 23 | 29 | 52 |
2022 April | 32 | 35 | 67 |
2022 March | 42 | 35 | 77 |
2022 February | 35 | 32 | 67 |
2022 January | 30 | 23 | 53 |
2021 December | 40 | 41 | 81 |
2021 November | 27 | 30 | 57 |
2021 October | 43 | 36 | 79 |
2021 September | 21 | 31 | 52 |
2021 August | 27 | 30 | 57 |
2021 July | 32 | 30 | 62 |
2021 June | 27 | 17 | 44 |
2021 May | 32 | 33 | 65 |
2021 April | 55 | 65 | 120 |
2021 March | 32 | 22 | 54 |
2021 February | 17 | 17 | 34 |
2021 January | 22 | 17 | 39 |
2020 December | 24 | 9 | 33 |
2020 November | 34 | 12 | 46 |
2020 October | 21 | 14 | 35 |
2020 September | 25 | 4 | 29 |
2020 August | 30 | 10 | 40 |
2020 July | 24 | 5 | 29 |
2020 June | 27 | 8 | 35 |
2020 May | 37 | 12 | 49 |
2020 April | 22 | 7 | 29 |
2020 March | 27 | 10 | 37 |
2020 February | 31 | 20 | 51 |
2020 January | 39 | 12 | 51 |
2019 December | 37 | 19 | 56 |
2019 November | 30 | 18 | 48 |
2019 October | 20 | 11 | 31 |
2019 September | 29 | 14 | 43 |
2019 August | 23 | 14 | 37 |
2019 July | 24 | 24 | 48 |
2019 June | 32 | 23 | 55 |
2019 May | 26 | 21 | 47 |
2019 April | 91 | 17 | 108 |
2019 March | 29 | 16 | 45 |
2019 February | 19 | 10 | 29 |
2019 January | 28 | 18 | 46 |
2018 December | 61 | 31 | 92 |
2018 November | 75 | 14 | 89 |
2018 October | 61 | 11 | 72 |
2018 September | 57 | 7 | 64 |
2018 August | 37 | 15 | 52 |
2018 July | 53 | 20 | 73 |
2018 June | 32 | 13 | 45 |
2018 May | 57 | 14 | 71 |
2018 April | 48 | 9 | 57 |
2018 March | 28 | 7 | 35 |
2018 February | 30 | 7 | 37 |
2018 January | 35 | 4 | 39 |
2017 December | 30 | 7 | 37 |
2017 November | 55 | 13 | 68 |
2017 October | 43 | 9 | 52 |
2017 September | 42 | 10 | 52 |
2017 August | 45 | 7 | 52 |
2017 July | 62 | 15 | 77 |
2017 June | 56 | 5 | 61 |
2017 May | 58 | 7 | 65 |
2017 April | 50 | 8 | 58 |
2017 March | 42 | 2 | 44 |
2017 February | 51 | 13 | 64 |
2017 January | 41 | 8 | 49 |
2016 December | 85 | 11 | 96 |
2016 November | 106 | 12 | 118 |
2016 October | 117 | 15 | 132 |
2016 September | 139 | 11 | 150 |
2016 August | 221 | 0 | 221 |
2016 July | 219 | 0 | 219 |
2016 June | 148 | 0 | 148 |
2016 May | 143 | 0 | 143 |
2016 April | 122 | 0 | 122 |
2016 March | 98 | 0 | 98 |
2016 February | 145 | 0 | 145 |
2016 January | 136 | 0 | 136 |
2015 December | 141 | 1 | 142 |
2015 November | 98 | 1 | 99 |
2015 October | 123 | 5 | 128 |
2015 September | 114 | 1 | 115 |
2015 August | 141 | 8 | 149 |
2015 July | 116 | 0 | 116 |
2015 June | 74 | 0 | 74 |
2015 May | 148 | 5 | 153 |
2015 April | 35 | 0 | 35 |