Vitamin D deficiency, parathyroid hormone levels, and bone disease among patients with end‐stage liver disease and normal serum creatinine awaiting liver transplantation. (21st April 2014)

• Record Type: Journal Article
• Authors: Corey, Rebecca L.; Whitaker, Michael D.; Crowell, Michael D.; Keddis, Mira T.; Aqel, Bashar; Balan, Vijayan; Byrne, Thomas; Carey, Elizabeth; Douglas, David D.; Harrison, M. Edwyn; Vargas, Hugo E.; Rakela, Jorge
• Is Part Of: Clinical transplantation. Volume 28:Number 5(2014:Sep./Oct.)
• Page Start: 579
• Page End: 584
• Publication Date: 2014-04-21
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.12351
• Languages: English
• ISSNs: 0902-0063

Abstract

<abstract abstract-type="main" id="ctr12351-abs-0001"> <title>Abstract</title> <sec id="ctr12351-sec-0001" sec-type="section"> <p>Vitamin D deficiency is common among patients with end‐stage liver disease (ESLD). The primary aim of our study was to assess the prevalence of vitamin D deficiency, secondary hyperparathyroidism, and bone disease in patients with ESLD awaiting LT.</p> </sec> <sec id="ctr12351-sec-0002" sec-type="section"> <title>Methods</title> <p>We retrospectively studied 190 patients at our center. Serum total 25‐hydroxyvitamin D (25‐OH D), parathyroid hormone (PTH), calcium, and bone mineral analysis (BMA) were recorded. Standard World Health Organization (WHO) criteria were used to diagnose osteopenia/osteoporosis. Only patients with normal serum creatinine were analyzed.</p> </sec> <sec id="ctr12351-sec-0003" sec-type="section"> <title>Results</title> <p>Thirty‐two of 190 patients were excluded from the final analysis (missing serum total 25‐OH D levels in three patients and elevated serum creatinine, 29 patients). 105 of 158 (66.4%) evaluable patients had 25‐OH D levels <25 ng/mL. Patients included in the analysis (n = 158) were divided according to serum total 25‐OH D levels: 0–10 ng/mL (n = 23), 11–20 ng/mL (n = 64), and >20 ng/mL (n = 71). There were no significant differences in mean serum PTH and corrected calcium levels among the three subgroups. Only three patients had elevated serum PTH. Patients with total 25‐OH D ≤ 10 ng/mL had higher model for end‐stage liver disease (MELD) scores vs. those with 25‐OH D > 20 ng/mL (13.3 ± 3, range 8–21, vs. 11.9 ± 3.4, range 6–29, p = 0.004). Irrespective of vitamin D status, bone disease was present in 64.6% of patients.</p> </sec> <sec id="ctr12351-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Low vitamin D levels and bone disease are common among patients with ESLD awaiting LT. Despite a high prevalence of low serum total 25‐OH D, our cohort maintained normal corrected calcium levels and did not develop secondary hyperparathyroidism. We propose that free serum 25‐OH D and vitamin D‐binding protein may be necessary to accurately establish the diagnosis of vitamin D deficiency in the setting of ESLD. Additional studies are needed to further define mechanisms of bone disease in patients with ESLD.</p> </sec> </abstract>