Low vitamin D linked to higher risk of renal disease in lupus

November 04, 2017

SAN DIEGO - Low levels of vitamin D were associated with higher rates of end-stage renal disease in patients with systemic lupus erythematosus, or lupus, according to new research findings presented this week at the 2017 ACR/ARHP Annual Meeting in San Diego.

Lupus is a chronic (long-term) inflammatory autoimmune disease in which an unknown trigger causes the body's immune system to attack its own healthy tissues. The most common type of lupus is systemic lupus erythematosus (SLE), a complex, multiple symptom autoimmune disease that can cause inflammation, pain and damage to various parts of the body. While anyone can develop lupus, it occurs 9-10 times more often in women than in men and is 2-3 times more common among women of color.

To clarify the role vitamin D levels may play in lupus inflammation, a group of researchers at Johns Hopkins University School of Medicine in Baltimore, Maryland, conducted a study to determine how low vitamin D levels could predict later organ damage. Low levels, defined as insufficiency or deficiency, of vitamin D is a common problem for patients with SLE. Some evidence suggests that vitamin D replacement therapy may help improve renal disease activity.

The researchers analyzed data on 1,392 SLE patients, including their first medical office visit where vitamin D levels were measured, and then their organ or tissue damage on all of the patient's follow-up clinic visits. The patients included in this study were 92 percent female, had a mean age of 47.3 years, and were 50 percent Caucasian and 41 percent African-American.

Patients were categorized based on 25-hydroxy vitamin D levels that were either below 20 nanograms (ng) per milliliter (ml), or at or above 20 ng/ml on their first office visit. At their first office visit where vitamin D levels were measured, 27.3 percent of the patients had levels below 20 ng/ml.

The researchers then calculated the risk of lifetime organ damage for patients with low vitamin D levels using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scoring system. Organ damage rates were also adjusted for age, gender and ethnicity.

"We have shown that supplementing vitamin D reduces urine protein, which is the best predictor of future renal failure," said Michelle A. Petri, MD, PhD, Director, Hopkins Lupus Center and a lead author of the study.

According to the study's results, the relative risk of renal damage was the highest for SLE patients whose vitamin D levels were insufficient, or a relative risk of 1.87 (1.66 adjusted). Skin damage was another concern, with a relative risk of 1.69 (1.22 adjusted). Total organ damage relative risk was 1.11 (1.17 adjusted). Other long-term outcomes measured included ocular, neuropsychiatric, pulmonary, cardiovascular, gastrointestinal and musculoskeletal, but the relative risk of damage to these organ systems was not significant. There was no association between low vitamin D and musculoskeletal damage, including osteoporotic fractures, in the study.

The researchers concluded low vitamin D is associated with a higher risk of total organ damage and with end-stage renal disease for patients with lupus.

"Supplementary vitamin D is very safe," said Dr. Petri. "It helps to prevent one of the most dreaded complications of SLE, and likely has a role in preventing blood clots and cardiovascular disease as well. Vitamin D supplementation, which can reduce proteinuria, should be a part of the treatment plan for lupus nephritis patients."

This research was supported by funding from the NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases.
-end-
About the ACR/ARHP Annual Meeting

The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR17 hashtag.

About the American College of Rheumatology

The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit http://www.rheumatology.org.

American College of Rheumatology

Related Lupus Articles from Brightsurf:

Systemic lupus erythematosus (SLE)
If renal remission is achieved therapeutically in cases of lupus nephritis (LN), the 10-year survival rate increases significantly.

Race-specific lupus nephritis biomarkers
A University of Houston biomedical researcher has discovered a difference in urinary biomarker proteins of lupus nephritis in patients according to race.

Lupus patients who take their medications lower their diabetes risk
Patients with lupus who take their medications as prescribed have much lower odds of developing type 2 diabetes, a common complication of the disease, finds a new study from the University of British Columbia.

Nearly 1 in 3 patients with lupus use prescription opioids for pain
A new study finds nearly one in three adults with lupus use prescription opioids to manage pain, despite a lack of evidence that opioids are effective for reducing pain from rheumatic diseases.

Developing therapeutic strategies for pregnant women with lupus
A highly gender-biased disease, lupus afflicts females some nine times more than males.

Lupus antibody target identified
Researchers have identified a specific target of antibodies that are implicated in the neuropsychiatric symptoms of lupus, according to human research published in JNeurosci.

B cells off rails early in lupus
Emory scientists could discern that in people with SLE, signals driving expansion and activation are present at an earlier stage of B cell differentiation than previously appreciated.

Can adverse childhood experiences worsen lupus symptoms?
Adverse childhood experiences (ACEs) encompass traumas such as abuse, neglect, and household challenges.

Unlocking the female bias in lupus
The majority of lupus patients are female, and new findings from the University of Pennsylvania shed light on why.

How a single faulty gene can lead to lupus
IBS-AIM (Academy of Immunology and Microbiology) research team at Pohang University of Science and Technology (POSTECH) in South Korea has discovered the role of a key gene involved in the autoimmune disease systemic lupus erythematosus (SLE) or lupus for short.

Read More: Lupus News and Lupus Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.