{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T15:01:41Z","timestamp":1767798101304,"version":"3.49.0"},"reference-count":22,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"2-Year Research Grant of Pusan National University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Chronic kidney disease (CKD) increases the risk of coronary artery disease (CAD), and vitamin D deficiency\u2014particularly reduced levels of 1,25-dihydroxyvitamin D [1,25(OH)2D], the biologically active form of vitamin D that declines early in CKD due to impaired renal conversion\u2014may be a contributing factor. This study aimed to assess the relationship between 1,25(OH)2D levels and the presence and severity of CAD in CKD patients. Materials and Methods: We retrospectively analyzed 398 non-dialysis CKD patients (eGFR &lt; 60 mL\/min\/1.73 m2) who underwent elective coronary angiography. Serum 1,25(OH)2D and 25(OH)D levels were measured, and CAD severity was assessed using the Gensini score. Results: Lower 1,25(OH)2D levels were independently associated with both the presence and se-verity of CAD. Logistic regression revealed that each 1 pg\/mL increase in 1,25(OH)2D was linked to an 11% reduction in odds of significant CAD (OR: 0.89; 95% CI: 0.86\u20130.93; p &lt; 0.001). In contrast, 25(OH)D was not significantly related to CAD. Linear regression showed an inverse correlation between 1,25(OH)2D and Gensini scores (\u03b2 = \u22120.329, p &lt; 0.001), indicating reduced disease severity with higher vitamin D levels. Subgroup analyses confirmed consistent associations across age, sex, diabetes, hypertension, and LDL-cholesterol categories. ROC analysis demonstrated that 1,25(OH)2D alone had good predictive ability for CAD (AUC = 0.818), which improved to 0.925 when combined with traditional risk factors. The optimal cutoff for 1,25(OH)2D was \u226416.6 pg\/mL, yielding 73.3% sensitivity and 83.5% specificity. Conclusions: Serum 1,25(OH)2D is an independent predictor of both the presence and extent of CAD in CKD patients and may serve as a valuable non-traditional biomarker for cardiovascular risk assessment.<\/jats:p>","DOI":"10.3390\/medicina62010124","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:46:43Z","timestamp":1767786403000},"page":"124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Active Vitamin D Level Is Independently Associated with the Presence and Severity of Coronary Artery Disease in Patients with Chronic Kidney Disease"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1731-6357","authenticated-orcid":false,"given":"Il Young","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"},{"name":"Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","article-title":"American Society of, Nephrology, European Renal, Association, International Society of, Nephrology Chronic Kidney Disease and the Global Public Health Agenda: An International Consensus","volume":"20","author":"Francis","year":"2024","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2024E007","DOI":"10.23876\/j.krcp.24.100","article-title":"World Kidney Day Joint Steering Committee. Mind the Gap in Kidney Care: Translating What We Know into What We Do","volume":"44","author":"Luyckx","year":"2025","journal-title":"Kidney Res. Clin. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1161\/CIRCULATIONAHA.120.050686","article-title":"Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options","volume":"143","author":"Jankowski","year":"2021","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.15420\/ecr.2021.30","article-title":"Coronary Artery Disease in Chronic Kidney Disease: Need for a Heart-Kidney Team-Based Approach","volume":"16","author":"Shroff","year":"2021","journal-title":"Eur. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.kint.2023.07.010","article-title":"Vitamin D Supplementation in People with Chronic Kidney Disease","volume":"104","author":"Vervloet","year":"2023","journal-title":"Kidney Int."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cosentino, N., Campodonico, J., Milazzo, V., De Metrio, M., Brambilla, M., Camera, M., and Marenzi, G. (2021). Vitamin D and Cardiovascular Disease: Current Evidence and Future Perspectives. Nutrients, 13.","DOI":"10.3390\/nu13103603"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e028561","DOI":"10.1161\/JAHA.122.028561","article-title":"Vitamin D Metabolites and Risk of Cardiovascular Disease in Chronic Kidney Disease: The Cric Study","volume":"12","author":"Hsu","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"869","DOI":"10.2310\/JIM.0b013e31825457cb","article-title":"Serum Vitamin D Levels Are Independently Associated with Severity of Coronary Artery Disease","volume":"60","author":"Akin","year":"2012","journal-title":"J. Investig. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.numecd.2014.12.005","article-title":"Circulating Vitamin D Levels Are Associated with the Presence and Severity of Coronary Artery Disease but Not Peripheral Arterial Disease in Patients Undergoing Coronary Angiography","volume":"25","author":"Liew","year":"2015","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"168","DOI":"10.2337\/dc11-1372","article-title":"Vitamin D Levels and Asymptomatic Coronary Artery Disease in Type 2 Diabetic Patients with Elevated Urinary Albumin Excretion Rate","volume":"35","author":"Joergensen","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s43044-023-00419-5","article-title":"Relationship between Vitamin D and Coronary Artery Disease in Egyptian Patients","volume":"75","author":"Algowhary","year":"2023","journal-title":"Egypt Heart J."},{"key":"ref_12","first-page":"10","article-title":"The Relationship between a Combination of Vitamin D Deficiency and Hyperuricemia and the Severity of Coronary Artery Disease in Myocardial Infarction Patients","volume":"48","author":"Somuncu","year":"2020","journal-title":"Turk Kardiyol. Dern. Ars."},{"key":"ref_13","first-page":"18","article-title":"Vitamin D Level and Extent of Coronary Stenotic Lesions in Patients with First Acute Myocardial Infarction","volume":"21","author":"Goleniewska","year":"2014","journal-title":"Cardiol. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/eci.12281","article-title":"Vitamin D Deficiency Is Independently Associated with the Extent of Coronary Artery Disease","volume":"44","author":"Verdoia","year":"2014","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1093\/eurheartj\/ehad165","article-title":"Vitamin D in Atherosclerosis and Cardiovascular Events","volume":"44","author":"Carbone","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1161\/CIRCULATIONAHA.113.002654","article-title":"Role of Vitamin D in Atherosclerosis","volume":"128","author":"Kassi","year":"2013","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Nardin, M., Verdoia, M., Nardin, S., Cao, D., Chiarito, M., Kedhi, E., Galasso, G., Condorelli, G., and De Luca, G. (2024). Vitamin D and Cardiovascular Diseases: From Physiology to Pathophysiology and Outcomes. Biomedicines, 12.","DOI":"10.3390\/biomedicines12040768"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1210\/me.2011-1329","article-title":"Vitamin D Receptor Signaling Inhibits Atherosclerosis in Mice","volume":"26","author":"Szeto","year":"2012","journal-title":"Mol. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1161\/01.CIR.94.5.1175","article-title":"Coronary Artery Calcification: Pathophysiology, Epidemiology, Imaging Methods, and Clinical Implications. A Statement for Health Professionals from the American Heart Association","volume":"94","author":"Wexler","year":"1996","journal-title":"Writing Group. Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1681\/ASN.2008111157","article-title":"25-Hydroxyvitamin D Levels Inversely Associate with Risk for Developing Coronary Artery Calcification","volume":"20","author":"Kestenbaum","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Legarth, C., Grimm, D., Kruger, M., Infanger, M., and Wehland, M. (2019). Potential Beneficial Effects of Vitamin D in Coronary Artery Disease. Nutrients, 12.","DOI":"10.3390\/nu12010099"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3109\/14017431.2015.1103893","article-title":"Effects of Vitamin D Supplementation as an Adjuvant Therapy in Coronary Artery Disease Patients","volume":"50","author":"Wu","year":"2016","journal-title":"Scand. Cardiovasc. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:10:26Z","timestamp":1767787826000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,7]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["medicina62010124"],"URL":"https:\/\/doi.org\/10.3390\/medicina62010124","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,7]]}}}