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International Urology and Nephrology

, Volume 50, Issue 12, pp 2255–2260 | Cite as

Low 1,25-dihydroxyvitamin D level is associated with erythropoietin deficiency and endogenous erythropoietin resistance in patients with chronic kidney disease

  • Il Young Kim
  • June Hyun Kim
  • Min Jeong Kim
  • Dong Won Lee
  • Cheol Gu Hwang
  • Miyeun Han
  • Harin Rhee
  • Sang Heon Song
  • Eun Young Seong
  • Soo Bong LeeEmail author
Nephrology - Original Paper
  • 129 Downloads

Abstract

Purpose

Erythropoietin (EPO) deficiency and resistance to endogenous EPO is an important pathophysiological feature in anemia of chronic kidney disease (CKD). Low 1,25 dihydroxyvitamin D [1,25(OH)2D] level is known to contribute to anemia of CKD. We aimed to investigate the associations between serum 1,25(OH)2D and anemia, EPO deficiency, and endogenous EPO resistance in patients with CKD.

Methods

This study included 409 patients with CKD [glomerular filtration rate (GFR) < 60 ml/min/1.73 m2] who were not on dialysis therapy. Patients on exogenous EPO therapy and patients with iron deficiencies were excluded. Endogenous EPO resistance was assessed by calculating the ratio of endogenous EPO to hemoglobin (Hb) (endogenous EPO/Hb ratio). The associations of Hb level, endogenous EPO level, and the endogenous EPO/Hb ratio with clinical and laboratory variables were investigated by univariate and multivariate analyses.

Results

In univariate analysis, serum 1,25(OH)2D level was correlated with the Hb level, endogenous EPO level, and the endogenous EPO/Hb ratio. Multiple regression analysis revealed that the serum 1,25(OH)2D level remained significantly associated with the Hb level (β = 0.532, P < 0.001), endogenous EPO level (β = 0.149, P = 0.010), and the endogenous EPO/Hb ratio (β = − 0.187, P = 0.002), even after adjusting for other confounding factors, including the levels of parathyroid hormone and the inflammatory marker C-reactive protein.

Conclusion

The serum 1,25(OH)2D level exhibited significant associations with anemia, EPO deficiency, and endogenous EPO resistance in CKD patients. These associations were independent of secondary hyperparathyroidism and inflammation status.

Keywords

1,25 Dihydroxyvitamin D Anemia Chronic kidney disease Erythropoietin 

Notes

Acknowledgements

This work was supported by a 2-Year Research Grant of Pusan National University.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies 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.

Informed consent

For retrospective type of this study, formal consent is not required.

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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Il Young Kim
    • 1
    • 2
    • 4
  • June Hyun Kim
    • 1
    • 2
    • 4
  • Min Jeong Kim
    • 1
    • 2
    • 4
  • Dong Won Lee
    • 1
    • 2
    • 4
  • Cheol Gu Hwang
    • 1
    • 3
  • Miyeun Han
    • 1
    • 3
  • Harin Rhee
    • 1
    • 3
  • Sang Heon Song
    • 1
    • 3
  • Eun Young Seong
    • 1
    • 3
  • Soo Bong Lee
    • 1
    • 2
    • 4
    Email author
  1. 1.Department of Internal MedicinePusan National University School of MedicineYangsanSouth Korea
  2. 2.Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanSouth Korea
  3. 3.Medical Research InstitutePusan National University HospitalBusanSouth Korea
  4. 4.Division of Nephrology, Department of Internal MedicinePusan National University Yangsan HospitalYangsanSouth Korea

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