Vitamin D Deficiency, Physical Performance and Cardiovascular Outcomes in CRIC

CRIC 中的维生素 D 缺乏、身体机能和心血管结局

• 批准号: 7316816
• 负责人: Mary Beth Leonard
• 金额: $ 51.28万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-15 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7316816
• 关键词: 1,25 (OH) vitamin D; Adult; Age; Ancillary Study; Animals; Blood Pressure; Body Weight decreased; Body mass index; Calcium; Cardiovascular Diseases; Cardiovascular system; Cells; Chronic Kidney Failure; Chronic Kidney Insufficiency; Clinical; Clinical Trials; Cohort Studies; Condition; Cross-Sectional Studies; Data; Dermal; Diabetes Mellitus; Dialysis patients; Dialysis procedure; Dietary intake; Disease Progression; End stage renal failure; Equilibrium; Excretory function; Foundations; Fracture; Functional disorder; Gait; Gender; Homeostasis; Hospitalization; Hypertension; Intake; Intestines; Kidney; Left; Left Ventricular Hypertrophy; Left Ventricular Mass; Maintenance; Measures; Metabolism; Minerals; Mixed Function Oxygenases; Monitor; Muscle; Muscle Weakness; Musculoskeletal; Myocardial; Myocardium; National Institute of Diabetes and Digestive and Kidney Diseases; Obesity; Observational Study; Outcome; Parathyroid Hormones; Parathyroid gland; Patient Self-Report; Patients; Performance; Pharmaceutical Preparations; Physical Dialysis; Physical Function; Physical activity; Physiologic calcification; Population; Prevalence; Proteins; Proteinuria; Race; Randomized Controlled Clinical Trials; Rate; Renal Glycosuria; Renal Osteodystrophy; Renal function; Research Personnel; Risk; Risk Factors; Seasons; Severities; Speed; Supplementation; Time; Tissues; Vascular calcification; Vitamin D; Vitamin D Deficiency; Vitamin D3 Receptor; base; clinical research site; cohort; disability; exhaustion; falls; frailty; grasp; human PTH protein; indexing; insight; mortality; phosphorus metabolism; programs; urinary; ventricular hypertrophy

DESCRIPTION (provided by applicant): Disturbances in vitamin D and mineral metabolism are early, pervasive complications of chronic renal insufficiency (CRI), and are associated with fractures, vascular calcification and mortality in patients with end-stage renal disease (ESRD). The classical function of vitamin D is to maintain calcium homeostasis by regulating intestinal and renal calcium transport, parathyroid hormne (PTH) secretion, and bone mineralization. However, the vitamin D receptor is widely expressed in other tissues, including muscle and myocardial cells. Numerous observational studies, clinical trials and animal studies have demonstrated that vitamin D deficiency in the absence of CRI is associated with muscle weakness, hypertension and left ventricular hypertrophy (LVH). Patients with CRI have numerous risk factors for vitamin D deficiency. Dialysis patients suffer increased fall and fracture rates, severely limited physical function, and markedly increased cardiovascular disease (CVD) mortality. The relations between vitamin D [25(OH)D and 1,25(OH)2D] and PTH levels, physical function and CVD have not been examined in CRI. The NIDDK CRI Cohort (CRIC) study was initiated in 2003 to identify risk factors for CVD and progression of CRI in adults with mild to severe CRI. This cohort provides an unprecedented, time-limited opportunity to investigate the risk factors and consequences of vitamin D deficiency in CRI. The proposed cross-sectional ancillary study in 1780 subjects at 4 clinical sites will add measures of 25(OH)D, 1,25(OH)2D, and PTH, as well as validated, standardized measures of physical performance (gait speed, standing balance, timed sit- to-stand) and frailty (involuntary weight loss, self-reported exhaustion, low physical activity, grip strength and gait speed) that predicted falls, disability, hospitalizations and mortality in varied populations. The aims of the study are: to determine the prevalence and risk factors for 25(OH)D deficiency in CRI; to determine the relations between 25(OH)D and 1,25(OH)2D according to renal function and PTH levels; and to determine the independent effects of 25(OH)D and 1,25(OH)2D levels on CVD, physical performance and frailty in CRI. Vitamin D deficiency likely contributes to the substantial burden of musculoskeletal and cardiovascular complications of CRI. Delineation of the relations between 25(OH)D and 1,25(OH)2D and clinical outcomes is necessary in order to develop anticipated randomized trials of vitamin D supplementation in CRI.

描述（由申请人提供）：维生素D和矿物质代谢的疾病是慢性肾功能不全（CRI）的早期，普遍的并发症，并且与终末期肾脏疾病（ESRD）患者的骨折，血管钙化和死亡率有关。维生素D的经典功能是通过调节肠道和肾脏钙转运，甲状旁腺荷尔蒙（PTH）分泌和骨矿化来维持钙稳态。但是，维生素D受体在其他组织中广泛表达，包括肌肉和心肌细胞。许多观察性研究，临床试验和动物研究表明，在没有CRI的情况下，维生素D缺乏与肌肉无力，高血压和左心室肥大（LVH）有关。 CRI患者有许多维生素D缺乏症的危险因素。透析患者跌倒率升高，骨折率升高，身体机能严重有限，并明显增加心血管疾病（CVD）死亡率。维生素D [25（OH）D和1,25（OH）2D]与PTH水平，身体功能和CVD之间的关系尚未在CRI中进行检查。 NIDDK CRI队列（CRIC）研究于2003年启动，以鉴定CVD的危险因素和轻度至重度CRI的成人CRI的进展。该队列提供了一个前所未有的时间限制的机会，以研究CRI中维生素D缺乏的危险因素和后果。 The proposed cross-sectional ancillary study in 1780 subjects at 4 clinical sites will add measures of 25(OH)D, 1,25(OH)2D, and PTH, as well as validated, standardized measures of physical performance (gait speed, standing balance, timed sit- to-stand) and frailty (involuntary weight loss, self-reported exhaustion, low physical activity, grip strength and gait speed) that predicted falls, disability,各种人口的住院和死亡率。该研究的目的是：确定CRI 25（OH）D缺乏的患病率和危险因素；根据肾功能和PTH水平，确定25（OH）D和1,25（OH）2D之间的关系；并确定25（OH）D和1,25（OH）2D水平对CVD的独立影响，在CRI中的身体表现和脆弱。维生素D缺乏可能会导致CRI的肌肉骨骼和心血管并发症的重大负担。为了开发CRI中补充维生素D的预期随机试验，必须描绘25（OH）D和1,25（OH）2D和临床结果之间的关系。