A low plasma 1,25(OH)2 vitamin D/PTH (1–84) ratio predicts worsening of renal function in patients with chronic heart failure

Serge Masson, Simona Barlera, Francesco Colotta, Michela Magnoli, Fabrizio Bonelli, Milena Moro, Roberto Marchioli, Luigi Tavazzi, Gianni Tognoni, Roberto Latini

Research output: Contribution to journalArticle

Abstract

Background Dysregulation of the vitamin D system promotes renal dysfunction and has direct detrimental effects on the heart. Progressive deterioration of renal function is common in patients with chronic heart failure (HF) and is invariably associated with unfavorable outcomes which can be improved by early identification and timely interventions. We examined the relation between two plasma markers of vitamin D metabolism and worsening of renal function (WRF) in a large cohort of patients with chronic HF. Methods Plasma levels of 1,25-dihydroxyvitamin D (1,25(OH)2D) and parathyroid hormone PTH (1–84) were measured in 1237 patients with clinical evidence of chronic and stable HF enrolled in the multicentre GISSI-HF trial and followed for 3.9 years. We examined the relation of 1,25(OH)2D, PTH(1–84), and their ratio with WRF, defined as first increase in serum creatinine concentration ≥ 0.3 mg/dL and ≥ 25% at two consecutive measurements at any time during the study. Results Lower 1,25(OH)2D/PTH(1–84) ratio was associated with a higher baseline serum concentration of creatinine, winter season, female sex and older age; 335 patients (29.6%) experienced an episode of WRF. After adjustment, a lower 1,25(OH)2D/PTH(1–84) ratio remained significantly associated with a higher risk of WRF (HR = 0.75 [0.62–0.90], p = 0.002) and correctly reclassified events. This ratio also independently predicted mortality and admission to hospital for cardiovascular reasons. Conclusions The plasma 1,25(OH)2D/PTH(1–84) ratio is a promising indicator of future risk of deterioration of renal function in patients with chronic HF and mild renal impairment, that may serve to optimize therapies and improve outcomes.

Original languageEnglish
Pages (from-to)220-225
Number of pages6
JournalInternational Journal of Cardiology
Volume224
DOIs
Publication statusPublished - Dec 1 2016

Keywords

  • 1,25-dihydroxyvitamin D
  • Heart failure
  • Parathyroid hormone
  • Worsening renal function

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

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