Vitamin D and parathyroid hormone in outpatients with noncholestatic chronic liver disease

Background & Aims: The liver plays a central role in vitamin D metabolism. Our aim was to determine the prevalence and type of vitamin D-parathyroid hormone (PTH) disturbance in ambulatory patients with noncholestatic chronic liver disease (CLD) and its relationship with disease severity and liver function. Methods: We studied 100 consecutive outpatients (63 men, 37 women; mean age, 49.0 +/- 12.1 [SD] y) with noncholestatic CLD caused by alcohol (n = 40), hepatitis C (n = 38), hepatitis B (n = 12), autoimmune hepatitis (n = 4), hemochromatosis (n = 4), and nonalcoholic steatohepatitis (n = 2); 51 patients had cirrhosis. Serum concentrations of 25-hydroxyvicamin D (25[OH]D), PTH, calcium, phosphate, magnesium, creatinine, and liver function tests were determined. Results: Serum 25(OH)D levels were inadequate in 91 patients: vitamin D deficiency (< 50 nmol/L) was found in 68 patients and vitamin D insufficiency (50 - 80 nmol/L) was found in 23 patients. Secondary hyperparathyroidism (serum PTH, > 6.8 pmol/L) was present in 16 patients. The prevalence of vitamin D deficiency was significantly higher in cirrhotic vs noncirrhotic patients (86.3% vs 49.0%; P =.0001). In Child-Pugh class C patients, 25(OH)D levels were significantly lower than in class A patients (22.7 +/- 10.0 nmol/L vs 45.8 +/- 16.8 nmol/L; P <.001). Serum 25(OH)D independently correlated with international normalized ratio (negatively; P =.018) and serum albumin (positively; P =.007). Serum 25(OH)D levels of less than 25 nmol/L predicted coagulopathy, hyperbilirubinemia, hypoalbuminemia, increased alkaline phosphatase, and anemia and thrombocytopenia. Conclusions: Vitamin D inadequacy is common in noncholestatic CLD and correlates with disease severity, but secondary hyperparathyroidism is relatively infrequent. Management of CLD should include assessment of vitamin D status in all patients and replacement when necessary.