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J Ren Nutr. 2012 Jul;22(4):423-33. doi: 10.1053/j.jrn.2011.10.006. Epub 2012 Jan 9.

Association of 1,25-dihydroxyvitamin D levels with physical performance and thigh muscle cross-sectional area in chronic kidney disease stage 3 and 4.

Author information

1
Division of Nephrology, Department of Medicine, University of California, San Francisco, California 94121, USA. patricia.gordon@ucsf.edu

Abstract

BACKGROUND:

Declines in 1,25-dihydroxyvitamin D (1,25(OH)₂D) levels and physical functioning follow the course of chronic kidney disease (CKD). Although the molecular actions of vitamin D in skeletal muscle are well known, and muscle weakness and atrophy are observed in vitamin D-deficient states, there is little information regarding vitamin D and muscle function and size in CKD.

OBJECTIVE:

To examine associations of vitamin D with physical performance (PF) and muscle size.

DESIGN:

Cross-sectional.

SETTING:

CKD clinic.

SUBJECTS:

Twenty-six patients (61 ± 13 years, 92% men) with CKD stage 3 or 4.

MAIN OUTCOME MEASURES:

Gait speed, 6-minute walk, sit-to-stand time, 1-legged balance, and thigh muscle cross-sectional area (MCSA), measured by magnetic resonance imaging (MRI).

RESULTS:

Overall, 73% were 25-hydroxyvitamin D (25(OH)D) deficient (n = 10) or insufficient (n = 9) (Kidney Disease Outcomes Quality Initiative guidelines). 25(OH)D level was associated with normal gait speed only (r = 0.41, P = .04). Normal and fast gait speed, the distance walked in 6 minutes, and sit-to-stand time were best explained by 1,25(OH)₂D and body mass index (P < .05 for all) and 1-legged stand by 1,25(OH)₂D (r = 0.40, P < .05) only. There were no associations of age, estimated glomerular filtration rate (eGFR), intact parathyroid hormone (iPTH), or albumin with any PF measures. MCSA was associated with eGFR (r = 0.54, P < .01) only. Variance in MCSA was best explained by a model containing 1,25(OH)₂D, plasma Ca²⁺, and daily physical activity (by accelerometry) (P < .05 for all). Once these variables were in the model, there was no contribution of eGFR.

CONCLUSION:

These results suggest that 1,25(OH)₂D is a determinant of PF and muscle size in patients with stage 3 and 4 CKD.

PMID:
22227183
PMCID:
PMC4815913
DOI:
10.1053/j.jrn.2011.10.006
[Indexed for MEDLINE]
Free PMC Article
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