The predictive factors of low serum 25-hydroxyvitamin D and vitamin D deficiency in patients with systemic lupus erythematosus
- 526 Downloads
Vitamin D is a steroid hormone with pleiotropic effects. The association between serum 25-hydroxyvitamin D level [25(OH) D] and lupus nephritis are not clearly known. We aim to determine serum 25(OH) D levels in patients with inactive SLE, active SLE without lupus nephritis (LN) and active SLE with LN and to identify clinical predictor of vitamin D deficiency. One hundred and eight SLE patients were included. Patients were classified as Group (Gr) 1, 2 and 3 if they had SLE disease activity index (SLEDAI) <3, ≥3 but no LN and ≥3 with LN. Important baseline characteristics were collected. 25(OH) D was measured by high performance liquid chromatography (HPLC). SLEDAI in Gr1, Gr2 and Gr3 was 0.7 (0.9), 5.6 (2.3) and 9.2 (5.2), respectively. 43.5 % had vitamin D insufficiency and 29.6 % had vitamin D deficiency. Mean 25(OH) D in each groups was 28.3 (8.0), 26.7 (9.5) and 19.9 (7.6) ng/ml (p < 0.001 comparing Gr1 and 3) (p = 0.003 comparing Gr2 and 3). Vitamin D deficiency was found in 11.1, 22.2 and 55.6 % of Gr1, 2 and 3. Linear regression analysis found that 25(OH) D was significantly correlated with serum albumin (r = 0.28, p = 0.004), inversely correlated with SLEDAI (r = −0.22, p = 0.03) and urinary protein creatinine index (UPCI) (r = −0.28, p = 0.005), but not with sun exposure score, body mass index and estimated GFR. Only UPCI was significantly inversely correlated with 25(OH) D (p = 0.02) from multiple linear regression. LN was a significant predictor of vitamin D deficiency from multivariate logistic regression (OR 5.97; p = 0.006). Vitamin D deficiency and insufficiency was found in 93 and 86 % of LN with proteinuria ≥ and <500 mg/day. We conclude that SLE patients with LN have significantly lower vitamin D level than inactive SLE and active SLE without LN. Hence, nephritis is a significant predictor of vitamin D deficiency in SLE patients.
Keywords25-Hydroxyvitamin D Vitamin D deficiency Serum 25(OH) D Systemic lupus erythematosus Lupus nephritis Proteinuria
This study was supported by The Research Fund of Rajavithi Hospital.
Conflict of interest
The authors have no disclosures or financial support relevance to this study to report.
- 6.de Zeeuw D, Agarwal R, Amdahl M, Audhya P, Coyne D, Garimella T, Parving HH, Pritchett Y, Remuzzi G, Ritz E, Andress D (2010) Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. Lancet 376(9752):1543–1551CrossRefPubMedGoogle Scholar
- 14.Uribe AG, Vila LM, McGwin G Jr, Sanchez ML, Reveille JD, Alarcon GS (2004) The systemic lupus activity measure-revised, the Mexican systemic lupus erythematosus disease activity index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus. J Rheumatol 31(10):1934–1940PubMedGoogle Scholar
- 15.Hanwell HE, Vieth R, Cole DE, Scillitani A, Modoni S, Frusciante V, Ritrovato G, Chiodini I, Minisola S, Carnevale V (2010) Sun exposure questionnaire predicts circulating 25-hydroxyvitamin D concentrations in Caucasian hospital workers in southern Italy. J Steroid Biochem Mol Biol 121(1–2):334–337CrossRefPubMedGoogle Scholar
- 16.Skversky AL, Kumar J, Abramowitz MK, Kaskel FJ, Melamed ML (2011) Association of glucocorticoid use and low 25-hydroxyvitamin D levels: results from the National Health and Nutrition Examination Survey (NHANES): 2001–2006. J Clin Endocrinol Metab 96(12):3838–3845CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Bogaczewicz J, Sysa-Jedrzejowska A, Arkuszewska C, Zabek J, Kontny E, McCauliffe D, Wozniacka A (2012) Vitamin D status in systemic lupus erythematosus patients and its association with selected clinical and laboratory parameters. Lupus 21(5):477–484Google Scholar