Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study

Lynda K Cameron; Lesedi Ledwaba-Chapman; Kieran Voong; Geeta Hampson; Lui G Forni; Nina Seylanova; Dominic J Harrington; Rosario Lim; Aneta Bociek; Wang Yanzhong; Marlies Ostermann

doi:10.1186/s13054-024-04869-4

Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study

Crit Care. 2024 Apr 2;28(1):108. doi: 10.1186/s13054-024-04869-4.

Authors

Lynda K Cameron^{1

2

3}, Lesedi Ledwaba-Chapman⁴, Kieran Voong⁵, Geeta Hampson^{6

7}, Lui G Forni^{8

9}, Nina Seylanova¹, Dominic J Harrington⁵, Rosario Lim¹, Aneta Bociek¹, Wang Yanzhong⁴, Marlies Ostermann¹⁰

Affiliations

¹ Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
² Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
³ Institute of Pharmaceutical Sciences, School of Cancer and Pharmacy, King's College London, London, SE1 9RT, UK.
⁴ Department of Population Health Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK.
⁵ Nutristasis Unit, Synnovis, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
⁶ Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
⁷ Department of Diabetes and Endocrinology, Metabolic Bone Clinic, St Thomas' Hospital, London, UK.
⁸ Department of Critical Care, Royal Surrey Foundation Trust, Guildford, Surrey, UK.
⁹ School of Medicine, University of Surrey, Guildford, Surrey, UK.
¹⁰ Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK. marlies.ostermann@gstt.nhs.uk.

Abstract

Background: Vitamin D deficiency in critically ill patients is associated with poor outcomes, and vitamin D supplementation is recommended for patients with chronic kidney disease. Whether acute kidney injury (AKI) is associated with altered Vitamin D metabolism is unknown. We aimed to compare the longitudinal profiles of serum 25(OH)D and 1,25(OH)₂D concentrations in critically ill patients with and without moderate to severe AKI and explore the impact of renal recovery and parathyroid hormone (PTH).

Methods: In this prospective, observational study in two centres in the UK, critically ill patients with and without AKI underwent serial measurement of serum 25(OH)D and 1,25(OH)₂D and plasma PTH concentrations for 5 days. Linear mixed model analysis and sensitivity analyses were performed.

Results: Serial data of 137 patients were analysed. Seventy-one patients had AKI stage II/III of whom 23 recovered kidney function during the 5-day study period; 66 patients did not have AKI at enrolment of whom 14 developed new AKI. On day of enrolment, patients' serum 25(OH)D concentrations were low (median 18 nmol/L) but there was no significant difference between patients with and without AKI. Median serum 1,25(OH)₂D levels were significantly lower in patients with AKI II/III (41 pmol/L [IQR 26, 58]) compared to similarly unwell patients without AKI (54 pmol/L [IQR 33, 69]) during the 5-day period. Recovery of kidney function in patients with AKI was associated with a rise in 1,25(OH)₂D concentrations. Plasma PTH results were impacted by serum calcium and magnesium levels but not associated with 1,25(OH)₂D levels.

Conclusions: Critically ill patients with moderate-to-severe AKI have significantly lower serum 1,25(OH)₂D concentrations than similarly sick patients without AKI but there was no difference in serum 25(OH)D concentrations. Recovery of AKI was associated with a rise in serum 1,25(OH)₂D concentrations. More research is needed to investigate the health benefits and safety of supplementation with active vitamin D in critically ill patients with moderate-to-severe AKI. Trial registration Clinicaltrials.gov (NCT02869919), registered on 16 May 2016.

Keywords: AKI; Acute kidney injury; Colecalciferol; Parathyroid hormone; Vitamin D.

Publication types

Observational Study

MeSH terms

Acute Kidney Injury*
Critical Illness
Humans
Parathyroid Hormone
Prospective Studies
Vitamin D
Vitamin D Deficiency* / complications

Substances

Vitamin D
Parathyroid Hormone

Associated data

ClinicalTrials.gov/NCT02869919