目的： 探讨血清维生素D水平对老年慢性肾脏病（chronic kidney disease, CKD）患者肾功能的影响。方法： 收集2014年1月至2019年5月在上海交通大学医学院附属瑞金医院肾脏科和老年科诊治的年龄≥60岁CKD 1~4期患者的临床及随访资料。采用化学发光法测定血清25羟维生素D[25（OH） D ]水平,按25（OH）D水平将患者分为维生素D缺乏组 [25（OH）D<50 nmol/L] 及不缺乏组 [包括充足及不足,即25（OH）D≥50 nmol/L]。比较2组患者基线临床及预后指标。结果： 共纳入347例老年CKD患者,与CKD1~2期患者相比,CKD 3期及以上患者的维生素D水平显著降低。维生素D缺乏发生率在CKD 1~2期和CKD 3期及以上患者的发生率分别为46.7%、67.6%。在CKD 3期及以上患者中,与维生素D不缺乏组相比,维生素D缺乏组患者甲状旁腺素、血尿酸及血肌酐水平较高,而血钙及估算的肾小球滤过率（estimated glomerular filtration rate,eGFR）较低,且维生素D缺乏组较不缺乏组发生eGFR下降≥30%或出现终末期肾脏病的比例较高（16.9%比2.9%,P=0.042）。多因素Logistic回归分析显示,维生素D缺乏独立于男性、年龄大、高平均动脉压、低血红蛋白、低白蛋白、高蛋白尿及高尿酸,为发生3期及以上CKD的独立风险因素。结论： 在老年CKD 3~4期患者中,维生素D缺乏组患者的eGFR显著下降,且维生素D缺乏是发生3期及以上CKD进展的独立危险因素。

Objective To investigate the association between vitamin D and chronic kidney disease (CKD) in elderly patients. Methods The clinical and follow-up data of elderly patients aged≥60 years diagnosed with CKD at stage 1-4 were collected in the Department of Nephrology and Department of Geriatrics of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2014 to May 2019. The serum 25-hydroxy vitamin D[25(OH)D] level was detected using photochemical method. All patients were divided into vitamin D deficiency group [25(OH)D<50 nmol/L] and non-deficiency group [including sufficient and insufficient levels of 25(OH)D, namely 25(OH)D≥50 nmol/L] according to 25(OH)D level. The baseline clinical and prognostic indicators were compared between two groups. Results Totally 347 elderly CKD patients were enrolled in this study. Compared to the patients with stage 1-2 CKD, the vitamin D level in those with stage 3-4 CKD was significantly lower. The incidence of vitamin D deficiency in the patients with stage 1-2 CKD and stage 3-4 CKD was 46.7% and 67.6%, respectively. Compared with the patients without vitamin D deficiency at stage 3-4 CKD, the patients with vitamin D deficiency at same stage had higher parathyroid hormone, serum uric acid, serum creatinine and rate of estimated glomerular filtration rate(eGFR) decline of at least 30% or progression into end-stage renal disease (16.9% vs 2.9%, P=0.042), and lower serum calcium and eGFR. The multivariate Logistic regression analysis showed that the vitamin D deficiency was an independent risk factor for the patients with stage 3-4 CKD after adjusting gender, age, mean arterial pressure, hemoglobin, albumin, proteinuria, and uric acid. Conclusions The patients with vitamin D deficiency at stages 3-4 CKD had significantly lower eGFR. The vitamin D deficiency is an independent risk factor for onset of CKD at stages 3-4.