The effect of some medications given to CKD patients on vitamin D levels

Nefrologia. 2015;35(2):150-6. doi: 10.1016/j.nefro.2015.05.016. Epub 2015 Jun 23.

Abstract

Background: Vitamin D deficiency and polypharmacy is a common problem over chronic kidney disease (CKD) population.

Objectives: To assess the clinical and analytical characteristics of CKD patients with 25-OH-D3 deficiency (<15 ng/mL), including the possible role of associated drugs.

Methods: A single center observational review of 137 incident patients referred to our outpatient clinic with different stages of CKD and 25-OH-D3<15ng/mL (male gender 53.3%, mean age 70.8 [±16.1] years, mean GFR (MDRD-4) 43.6 [±25.5] ml/min/1.73 m²). 25-OH-D3 levels were collected in spring. Clinical and biochemical data and associated medications were recorded.

Results: Mean 25-OH-D3 levels were 8.23 [±4.03] ng/ml. Eighty-eight patients (64.7%) had 3 or more concomitant drugs. Only 7 patients (5.1%) were not receiving any medication. Patients were divided in three groups according the therapies into none (n=26), RAS inhibitors or allopurinol (n=81), and RAS inhibitors plus allopurinol (n=30); with the aim to study the influence of statin therapy. Patients under renin angiotensin (RAS) inhibitors or Allopurinol treatment presented significantly higher 25-OH-D3 levels (p=0.001 and p=0.01 respectively), however patients with Statins treatment had lower 25-OH-D3 level (p=0.039). Personal history of diabetes, cardiovascular events or other therapies did not modify 25-OH-D3 levels, adjusted by age and eGFR.

Conclusions: CKD patients with vitamin D deficiency who received RAS inhibitors or Allopurinol treatment had higher 25-OH-D3 levels, however those with statins treatment had lower vitamin D levels. Randomized controlled trials are required to confirm these findings.

Keywords: Allopurinol; Alopurinol; Chronic kidney disease; Enfermedad renal crónica; Estatinas; Inhibidores RAS; RAS inhibitors; Statins; Vitamin D; Vitamina D.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Allopurinol / adverse effects
  • Allopurinol / pharmacokinetics*
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / pharmacokinetics*
  • Calcifediol / blood*
  • Calcifediol / deficiency
  • Cross-Sectional Studies
  • Drug Interactions
  • Female
  • Glomerular Filtration Rate
  • Hematinics / adverse effects
  • Hematinics / pharmacokinetics*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / pharmacokinetics*
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / pharmacokinetics*
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Phosphates / blood
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / drug therapy
  • Renin-Angiotensin System / drug effects
  • Vitamin D / blood*
  • Vitamin D Deficiency / chemically induced*
  • Vitamin D Deficiency / etiology

Substances

  • Antihypertensive Agents
  • Hematinics
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypoglycemic Agents
  • Parathyroid Hormone
  • Phosphates
  • Vitamin D
  • Allopurinol
  • Calcifediol