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Vitamin D deficiency linked to increased risk for renal disease in patients with SLE
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SAN DIEGO — Low levels of vitamin D were associated with elevated rates of end-stage renal disease among patients with systemic lupus erythematosus, according to findings presented at the American College of Rheumatology Annual Meeting.
“Approximately 50% of people with lupus who are Caucasian will get kidney disease; this number is probably closer to 75% for African-Americans, and just as severe among Hispanic-Americans,” Michelle A. Petri, MD, PhD, director of the Johns Hopkins Lupus Center, said during a press conference. “Given that our current therapy is insufficient, most rheumatologists in the lupus field consider lupus–kidney disease to be our major unmet need.”
Although previous studies have demonstrated supplementation with 25-hydroxyvitamin D may help renal disease activity, Petri and colleagues attempted to determine whether low vitamin D levels predicted later organ damage. To assess the role of vitamin D levels in SLE inflammation, the researchers examined data from 1,392 patients with SLE, including vitamin D levels during their first medical visit, as well as reported organ or tissue damage on their subsequent visits.
The researchers categorized patients based on their preliminary vitamin D level measurements, either greater or less than 20 ng/mL. Overall, 27.3% of patients had levels of 25-hydroxyvitamin D of less than 20 ng/mL.
According to study results, risk of renal damage was greatest for patients with SLE with deficient vitamin D levels, with increased risk also observed for skin damage (RR=1.69; adjusted RR=1.22) and total organ damage (RR=1.11; adjusted RR=1.17).
“We found that our patients with the very lowest levels of vitamin D – below 20 ng/mL – had a 66% increased risk of end-stage renal disease, meaning that they were going to progress to require either dialysis or transplant,” Petri said.
Although other long-term outcomes included ocular, neuropsychiatric, pulmonary, cardiovascular, gastrointestinal and musculoskeletal, researchers found the relative risk of damage to these systems was not significant. In addition, Petri and colleagues observed no link between low vitamin D and musculoskeletal damage, including osteoporotic fractures.
“Since we know that urine protein is the best predictor of end-stage renal disease, that vitamin D can reduce proteinuria and we now know that patients that get end-stage renal failure are those with the lowest levels of vitamin D, my hope is that we provide something safe and helpful,” Petri said. “[Supplementation] will never replace the ‘big guns’ – the immune suppression medicine – but because vitamin D is cheap and safe, we can give it to everyone. Additionally, we found that it wasn’t necessary to get the 25-hydroxyvitamin D level above 40 ng/mL because we didn’t gain any extra benefit from higher levels, so we have set a very simple target: achieve a level of 40 ng/mL in everyone with lupus.”-by Bob Stott
Reference:
Petri MA, et al. Abstract 665. Presented at: American College of Rheumatology Annual Meeting; Nov. 4-8, 2017; San Diego.
Disclosures: Petri report receiving research support from Anthera, Amgen, Bristol-Myers Squibb, Eli Lilly, EMD Serono, Exagen, GlaxoSmithKline, Global Academy and United Rheumatology. Please see the full study for a complete list of all other authors’ relevant financial disclosures.