Patients Aged 80 Years or Older are Encountered More Potentially Inappropriate Medication Use / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Polypharmacy and potentially inappropriate medications (PIMs) are prominent prescribing issues in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65-79 years of age and 80 years or older, who were discharged from Geriatric Department in West China Hospital.</p><p><b>METHODS</b>A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively, 618 patients were 65-79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the American Geriatric Society was applied to assess the use of PIM among the investigated samples.</p><p><b>RESULTS</b>A review of the prescribed medications identified 686 patients aged 80 years or older consumed at least one PIM giving a rate of 58.2%. Conversely, 268 (43.4%) patients aged 65-79 years consumed at least one PIM (χ2 = 40.18, P < 0.001). Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65-79 years (all with P < 0.001). Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication.</p><p><b>CONCLUSIONS</b>The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65-79 years. Anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older.</p>

Association of fasting serum insulin and fasting serum glucose levels with cognitive impairment in Chinese nonagenarians/centenarians.

In this study, we examined the association of fasting serum insulin (FSI) and fasting serum glucose (FSG) with cognitive impairment in the very elderly using a sample of Chinese nonagenarians/centenarians. This study used data from a survey that was conducted in 2005 on all residents aged 90 years or more in a district with 2,311,709 inhabitants. FSG, FSI, and cognitive function were analyzed. The sample included 661 unrelated Chinese individuals (aged 90-108 years; mean, 93.52 ± 3.37 years; 67.17 % women; FSI, 6.27 ± 2.27 mU/mL; FSG levels, 4.46 ± 1.45 mmol/L). The prevalence of cognitive impairment was 61.81 % and that of hypoinsulinemia was 31.92 %. Individuals with hypoinsulinemia showed lower cognitive function scores (14.81 ± 5.79 vs. 15.78 ± 5.24, t = 2.160, P = 0.031). No differences in cognitive function score between different FSI and FSG groups were significant, and no differences in FSI and FSG between individuals with and without cognitive impairment were statistically significant. Unadjusted multiple logistic regressions showed that hypoinsulinemia, impaired fasting glucose, or diabetes did not change the risk of cognitive impairment significantly. In summary, we found that in elderly subjects, cognitive function appeared associated with FSI, and higher FSI may be associated with enhanced cognitive function.

Cigarette smoking is associated with increased diastolic blood pressure among Chinese nonagenarians/centenarians.

OBJECTIVE: Cigarette smoking has been confirmed as a factor influencing arterial blood pressure. In the present study, we studied whether cigarette smoking habits were still associated with arterial blood pressure among Chinese nonagenarians/centenarians. METHODS: The present study analyzed data from a survey conducted on all residents aged 90 years or more in the DuJiangYan district (in total 2,311,709 inhabitants) in 2005. RESULTS: The individuals included in the statistical analysis were 216 men and 445 women. Individuals who were heavy smokers (76.62 ± 13.28 mmHg) had higher diastolic blood pressure, compared with medium and light smokers (72.33 ± 12.98 and 70.28 ± 10.31 mmHg) (F = 3.551, p = 0.030). There was a higher prevalence of diastolic hypertension (21.62% vs 5.75% and 7.14%, χ(2 =) 6.302, p = 0.043). Furthermore, there was a higher risk for diastolic hypertension in heavy smokers (OR = 3.886, 95% CI 1.241-12.161) (adjusted) compared with medium (OR = 1.475, 95% CI 0.599-3.360) and light smokers (1.00 reference). There was, however, no significant difference in systolic blood pressure or prevalence of systolic hypertension among the different smoking groups. CONCLUSIONS: In summary, we found that among Chinese nonagenarians/centenarians, heavy smoking (current or former) could increase diastolic blood pressure and prevalence of diastolic hypertension, but was not associated with changes in systolic blood pressure.

Association of sleep quality and dementia among long-lived Chinese older adults.

In this study, we examined the existence of relationship between sleep quality and dementia in subjects aged 90 years and above. The sample included 216 men and 444 women. Dementia and sleep quality were measured with 30-item mini-mental state examination (MMSE) and the Pittsburgh sleep quality index, respectively. Subjects with dementia had higher sleep quality score (7.83 ± 2.15 vs. 5.22 ± 2.49; P < 0.0001), longer sleep latency (50.97 ± 21.33 vs. 37.61 ± 12.53; P < 0.0001), and a lower sleep efficiency percentage (73.95 ± 8.783 vs. 81.32 ± 10.21; P < 0.0001) and more likely to report poor sleep quality (25.42 vs.17.13 %; P = 0.035). Subjects with poor sleep quality had significantly lower MMSE scores (P = 0.007) and higher prevalence of dementia (P = 0.042). Multiple logistic regressions were performed by adjusting clinical factors that are thought to be associated with dementia or sleep quality. We found that poor sleep quality was a risk factor for dementia (unadjusted odds ratio (OR) 1.719, 95 % confidence interval (CI) 1.138-2.597; adjusted OR 1.759, 95 % CI 1.012-3.057). There was no significant difference in MMSE scores (11.25 ± 3.40, 16.26 ± 5.14, and 15.43 ± 5.51; P = 0.105) among participants with daily average sleep durations of <5, 5-9, and >9 h, respectively. Among Chinese nonagenarians and centenarians, dementia was correlated with poor sleep quality, longer sleep latency, and lower sleep efficiency percentage.

Cigarette smoking and its association with serum lipid/lipoprotein among Chinese nonagenarians/centenarians.

OBJECTIVE: Cigarette smoking had been confirmed as an increased risk for dyslipidemia, but none of the evidence was from long-lived population. In present study, we detected relationship between cigarette smoking habits and serum lipid/lipoprotein (serum Triglyceride (TG), Total cholesterol (TC), Low-density lipoprotein (LDL) and high-density lipoprotein (HDL)) among Chinese Nonagenarians/Centenarian. METHODS: The present study analyzed data from the survey that was conducted on all residents aged 90 years or more in a district, there were 2,311,709 inhabitants in 2005. Unpaired Student's t test, χ2 test, and multiple logistic regression were used to analyze datas. RESULTS: The individuals included in the statistical analysis were 216 men and 445 women. Current smokers had lower level of TC (4.05 ± 0.81 vs. 4.21 ± 0.87, t = 2.403, P = 0.017) and lower prevalence of hypercholesteremia (9.62% vs. 15.13%, χ2 = 3.018,P = 0.049) than nonsmokers. Unadjusted and adjusted multiple logistic regressions showed that cigarette smoking was not associated with risk for abnormal serum lipid/lipoprotein. CONCLUSIONS: In summary, we found that among Chinese nonagenarians/centenarians, cigarette smoking habits were not associated with increased risk for dyslipidemia, which was different from the association of smoking habits with dyslipidemia in general population.

Association between sleep quality and cognitive impairment among Chinese nonagenarians/centenarians.

PURPOSE: The authors examined the individual association between sleep quality and cognitive function among the very elderly. METHODS: The present study analyzed data from a survey that was conducted on all residents aged 90 years or older in a district; there were 2,311,709 inhabitants in 2005. Cognitive function and sleep quality were measured using the 30-item Mini-Mental State Examination and the Pittsburgh Sleep Quality Index, respectively. RESULTS: The subjects included in the statistical analysis were 216 men and 444 women. Subjects with poor sleep quality had significant lower cognitive function scores (P = 0.007) and higher prevalence of cognitive impairment (P = 0.035). Subjects with cognitive impairment had longer sleep latency (P < 0.0001) and lower sleep efficiency percentage (P = 0.006) and more likely reported with poor quality (P = 0.035). Multiple logistic regressions showed that poor sleep quality was a risk factor for cognitive impairment (unadjusted odds ratio, 1.719; 95% confidence interval, 1.138-2.597; adjusted odds ratio, 1.759; 95% confidence interval, 1.012-3.057). CONCLUSIONS: Among longevity Chinese, there is an association between sleep quality and cognitive function, and cognitive impairment is associated with poor quality, longer sleep latency, and lower sleep efficiency percentage.

Association between sleep quality and arterial blood pressure among Chinese nonagenarians/centenarians.

BACKGROUND: There is association between sleep quality and arterial blood pressure, but it is still unclear if the association also exists in the very elderly. We examined the individual association between sleep quality and arterial blood pressure among the very elderly. MATERIAL/METHODS: The present study analyzed data from a survey that was conducted on all residents aged 90 years or older in a district with 2,311,709 inhabitants in 2005. Sleep quality was measured using The Pittsburgh Sleep Quality Index (PSQI). RESULTS: The subjects included in the statistical analysis were 216 men and 444 women. There were no significant differences in sleep quality scores, sleep latency, and sleep efficiency percentage and prevalence of poor sleep quality between subjects with and without hypertension. None of the differences in systolic blood pressure, diastolic blood pressure, and prevalence of hypertension, systolic hypertension and diastolic hypertension among subjects with well, fairly and poor sleep quality were significant. Multiple logistic regressions showed that unadjusted and adjusted Odds Ratio (ORs) of poor sleep quality for increased risk for hypertension were significant. CONCLUSIONS: Among very elderly subjects, there was no association between sleep quality and arterial blood pressure.

Association between sleep quality and body mass index among Chinese nonagenarians/centenarians.

We examined the individual association between body mass index (BMI) and sleep quality among the very elderly. The present study analyzed data from survey that was conducted on all residents aged 90 years or more in a district, there were 2,311,709 inhabitants in 2005. Subjects were divided into four groups according to quartile of BMI (<16.6, 16.6-18.9, 18.9-21.1, >21.1 kg/m(2)) and according to classification criteria of underweight, normal weight, overweight, and obesity in BMI (<18.5, 18.5-23.0, 23.0-27.5, >27.5 kg/m(2)), respectively. Sleep quality was measured using The Pittsburgh Sleep Quality Index (PSQI). Sleep quality included quality classification and scores, sleep duration, sleep latency, and sleep efficiency. The subjects included in the statistical analysis were 216 men and 444 women. According to quartile of BMI or classification criteria of underweight, normal weight, overweight, and obesity in BMI, none of the differences in sleep quality scores, sleep latency, sleep duration, sleep efficiency percentage, and prevalence of poor sleep quality was significant among different BMI groups. The difference in BMI between subjects with good and poor sleep quality was non-significant. Unadjusted and adjusted multiple logistic regression showed that none of the BMI groups had a function of decreasing the risk for poor quality. Among longevity Chinese, there is no association between BMI and sleep quality.

Serum lipid/lipoprotein and arterial blood pressure among Chinese nonagenarians/centenarians.

OBJECTIVE: In the present study, we detected a relationship between serum lipid/lipoprotein [serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL)-cholesterol and high-density lipoprotein (HDL)-cholesterol] and arterial blood pressure among Chinese nonagenarians/centenarian. METHODS: The present study analyzed data from the survey that was conducted on all residents aged 90 years or more in a district; there were 2,311,709 inhabitants in 2005. Arterial blood pressure included systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: The subjects included in the statistical analysis were 217 men and 444 women. Subjects with hypertension (1.29 ± 0.74 vs 1.13 ± 0.45, t = 3.362, p = 0.001) or systolic hypertension (1.30 ± 0.74 vs 1.12 ± 0.45, t = 3.534, p < 0.0001) had higher levels of TG than those without. Subjects with abnormal levels of serum TG had higher SBP (145 ± 22 vs 139 ± 23, t = 2.223, p = 0.027). The Pearson correlation showed a significant relationship between SBP and serum TG levels (r = 0.088, p = 0.024). Unadjusted and adjusted multiple logistic regressions showed that hypertension or systolic hypertension was associated with an increased risk of abnormal of serum TG levels. CONCLUSIONS: In summary, we found that among Chinese nonagenarians and centenarians, the levels of serum lipid/lipoprotein were associated with arterial blood pressure. Hypertriglyceridemia was associated with SBP.

Depression and hypertension among Chinese nonagenarians and centenarians.

PURPOSE: In this study, we explored association between hypertension and depression in the very elderly using a sample ranged in age from 90 to 108 years. METHODS: A cross-sectional study. RESULTS: The sample included 687 unrelated Chinese nonagenarians/centenarians (67.4% women, mean age 93.51 years). The mean depression score (measured with brief 23-item geriatrics depression scale Chinese-edition (GDS-CD)) was 8.46 (standard deviation (SD) 3.33 range 0-20). There was no significant difference in depression scores between subjects with and without hypertension and there was also no significant difference in depression prevalence between subjects with and without hypertension. There was no significant difference in prevalence of hypertension between subjects with and without depression and there were also no significant differences in levels of arterial blood pressure (including SBP and DBP). Neither odd ratio (OR) of depression as a function of increased hypertension nor OR of hypertension as a function of increased depression was significant. CONCLUSIONS: In summary, we found that depression was not directly correlated with hypertension among Chinese nonagenarians and centenarians.

Cognitive impairment and depression among Chinese nonagenarians/centenarians.

PURPOSE: In this study, we explored the association between cognitive impairment and depression in the very elderly using a sample aged 90-108 years. METHODS: A cross-sectional study. RESULTS: The sample included 682 unrelated Chinese nonagenarians/centenarians (67.25% women, mean age of 93.49 years). The mean depression score (measured with the brief 23-item Geriatrics Depression Scale-Chinese Edition was 8.45 (standard deviation [SD] = 3.30). The mean of cognitive function scores (measured with the 30-item Mini-Mental State Examination) was 15.54 (SD = 5.38). There was no significant difference in cognitive function scores between subjects with and without depression, and there was also no significant difference in depression scores between subjects with and without cognitive impairment. There was also no significant difference in the frequency of depression between subjects with and without cognitive impairment or in the frequency of cognitive impairment between subjects with and without depression. Both the odds ratio (OR) of depression (as a function of increased cognitive impairment) and the OR of cognitive impairment (as a function of increased depression) were found to be insignificant. Pearson Correlation also showed no significant correlation between depression scores and cognitive function scores. CONCLUSIONS: In summary, we found that depression was not directly correlated with cognitive impairment in Chinese nonagenarians and centenarians.

Health status and risk for depression among the elderly: a meta-analysis of published literature.

OBJECTIVE: the goal of this study was to determine the relationship between health status, including self-rated health status and chronic disease, and risk for depression among the elderly. METHOD: MEDLINE, EMBASE and The Cochrane Library Database were used to identify potential studies. The studies were classified into cross-sectional and longitudinal subsets. For each study, the numbers of the total participants, cases (for cross-sectional study) or incident cases (for longitudinal study) of depression in each health status group were extracted and entered into Review Manager 4.2. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were performed, respectively. For prevalence and incidence rates of depression, odds risk and relative risk (RR) were calculated, respectively. RESULTS: the quantitative meta-analysis showed that, compared with the elderly without chronic disease, those with chronic disease had higher risk for depression (RR: 1.53, 95% confidence intervals (CI): 1.20-1.97). Compared with the elderly with good self-rated health, those with poor self-rated health had higher risk for depression (RR: 2.40, 95% CI: 1.94-2.97). CONCLUSIONS: despite the methodological limitations of this meta-analysis, both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly. In the elderly, poor self-reported health status appears to be more strongly associated with depression than the presence of chronic disease.

Pro12Ala polymorphism in PPARgamma2 associated with depression in Chinese nonagenarians/centenarians.

BACKGROUND AND AIMS: The Pro12Ala polymorphism of peroxisome proliferator-activated receptor-gamma (PPARgamma) has been associated with decreased obesity, insulin resistance, type 2 diabetes and other age-associated diseases such as cognitive impairment, hypertension, cancer, osteoarthritis. Each one of these diseases had been linked to depression. Moreover, there is also an association between Pro12 Ala polymorphism in PPAR gamma2 and longevity. The aim of the study was to evaluate the association between Pro12 Ala polymorphism and depression in Chinese nonagenarians and centenarians. METHODS: The sample included 697 unrelated Chinese nonagenarians/centenarians (aged between 90-108 years, mean age: 93.5+/-3.35 years; 67.2% women). The Pro12Ala variant was examined using polymerase chain reaction-restriction fragment length polymorphism. Depression was measured with brief 23-item Geriatrics Depression Scale Chinese-edition (GDS-CD). RESULTS: In this sample, the genotype frequencies of the Pro12Ala polymorphism were 0% Ala12Ala, 9.2% Pro12Ala, 90.8% Pro12Pro and the prevalence of depression was 25.3%. Subjects who were 12Ala carriers had significantly lower prevalence of depression than those who were not 12Ala carriers (14.06 vs. 26.38%, p=0.034). Subjects without depression also had a higher frequency of 12Ala gene than those with depression (5.28 vs. 2.56%, p=0.031). Adjusting for certain clinical factors that may be associated with depression or with 12Ala carriers, multiple logistic regressions showed the 12Ala gene was associated with decreased incidence of depression. CONCLUSIONS: In summary, we found that among Chinese nonagenarians and centenarians, the Pro12Ala polymorphism in PPARgamma2 was associated with depression and that the 12Ala gene may be a factor for decreased depression.

Collaborative care interventions for depression in the elderly: a systematic review of randomized controlled trials.

OBJECTIVE: To determine the effective components and the feasibility of collaborative care interventions (CCIs) in the treatment of depression in older patients. METHODS: Systematic review of randomized controlled trials, in which CCIs were used to manage depression in patients aged 60 or older. RESULTS: We identified 3 randomized controlled trials involving 3930 participants, 2757 of whom received CCIs and the others received usual care. Collaborative care interventions were more effective in improving depression symptoms than usual care during each follow-up period. Compared with baseline, thoughts of suicide in subjects receiving CCIs significantly decreased (odds Ratio [OR], 0.52; 95% confidence intervals [CI], 0.35-0.77), but not that in those receiving usual care (OR, 0.85; 95% CI, 0.50-1.43). Subjects receiving CCIs were significantly more likely to report depression treatment (including any antidepressant medication and psychotherapy) than those receiving usual care during each follow-up period. Collaborative care interventions significantly increased depression-free days, but did not significantly increase outpatient cost. At 6 and 12 months postintervention, compared with those receiving usual care, participants receiving CCIs had lower levels of depression symptoms and thoughts of suicide. Moreover, participants receiving CCIs were significantly more likely to report antidepressant medication treatment, but were not significantly more likely to report psychotherapy. Collaborative care interventions with communication between primary care providers and mental health providers were no more effective in improving depression symptoms than CCIs without such communication. CONCLUSIONS: Collaborative care interventions are more effective for depression in older people than usual care and are also of high value. Antidepressant medication is a definitely effective component of CCIs, but communication between primary care providers and mental health providers seems not to be an effective component of CCIs. The effect of psychotherapy in CCIs should be further explored.

Insufficient renal 1-alpha hydroxylase and bone homeostasis in aged rats with insulin resistance or type 2 diabetes mellitus.

This study aimed to explore the relationship between insufficient renal 1-alpha hydroxylase (IRH) and bone homeostasis in type 2 diabetes mellitus (T2DM) or insulin resistance (IR) and to investigate whether IR plays a major role in the pathogenesis of both IRH and bone loss in T2DM. The experimental animal models of T2DM, IR, IR treated with vitamin D (VD), IR treated with 1-alpha hydroxyvitamin D (1alpha(OH) D, the product of renal 1-alpha hydroxylase), T2DM treated with VD, and T2DM treated with 1alpha(OH) D were established on 18-month-old male Wistar rats. For rats in each animal model and normal control rats, IR was detected by euglycemic insulin clamp technique (EICT) and glucose infusion rate (GIR, an index of IR) was calculated. Levels of serum 25-hydroxyvitamin D (25(OH)D) and serum active vitamin D (1,25(OH)(2)D) were determined by radioimmunoassay (RIA), and 1,25(OH)(2)D/25(OH)D ratio (1,25-25-R, an index of renal 1-alpha hydroxylase activity in vivo) was calculated; and bone mineral density (BMD) in femoral bone and lumbar vertebrae was measured by dual-energy X-ray absorption (DEXA). No significant difference was observed among the levels of 25(OH)D in all the rats. In IR rats, 1,25(OH)(2)D level, 1,25-25-R, and BMD level were significantly higher than those in T2DM rats and were lower than those in normal control rats. In the aged rats with T2DM or IR, administration of VD had no effect on 25(OH)D level, 1,25(OH)(2)D level, 1,25-25-R, and BMD level. Administration of 1alpha(OH) D had also no effect on 25(OH)D level but increased 1,25(OH)(2)D level, 1,25-25-R, and BMD level. For the aged rats with T2DM or IR, GIR positively correlated with both levels of 1,25(OH)(2)D and BMD, and 1,25-25-R positively and significantly correlated with levels of BMD. In T2DM or IR, IRH is a precipitating factor for bone loss. IR seems to play a major role in the pathogenesis of both IRH and bone loss in T2DM.

Renal injury, abnormal vitamin D metabolism and bone homeostasis in aged rats with insulin resistance or type 2 diabetes mellitus.

OBJECTIVE: The study aimed to explore the relationship among renal injury, abnormal vitamin D metabolism, and bone homeostasis in insulin resistance (IR) or type 2 diabetes mellitus (T2DM). DESIGN AND METHODS: The animal models of IR, T2DM, and T2DM treated with 1-alpha hydroxyvitamin D (1-alphaOHD) were established on 18-month-old male Wistar rats. Glucose infusion rates (GIR) and levels of urinary albumin (UA), serum 25-hydroxyvitamin D (25-(OH)D), serum 1,25-dihydroxyvitamin D (1,25-OH2D), and bone mineral density (BMD) in lumbar vertebrae and femoral bone were measured. RESULTS: Urinary albumin level in the rats with T2DM significantly increased, and there existed a significant and negative correlation between GIR and UA level in the rats with T2DM or IR. The levels of serum 25-OHD in all models were similar. The levels of serum 1,25-OH2D and BMD in the rats with IR were significantly higher than those in the rats with T2DM and were lower than those in normal control rats. In the aged rats with T2DM, administration of 1-alphaOHD had no effect on serum 25-OHD level although significantly increased the levels of serum 1,25-O2D and BMD. There existed a negative correlation between the levels of serum 1,25-(OH)2D and UA in the rats with T2DM or IR. CONCLUSIONS: In IR or T2DM, abnormal vitamin D metabolism is characterized by 1,25-OH2D deficiency and is related to renal injury, and there also existed bone loss. In T2DM, both 1,25-(OH)2D deficiency and bone loss can be reversed by 1-alphaOHD.

Insulin resistance, renal injury, renal 1-alpha hydroxylase, and bone homeostasis in aged obese rats.

BACKGROUND: This study aimed to explore the relationship among insulin resistance (IR), renal injury, renal 1-alpha hydroxylase activity (RHA), and bone homeostasis in the presence of obesity. METHODS: Obesity, obesity treated with vitamin D, and obesity treated with 1-alpha hydroxyvitamin D [1-alpha(OH)D] were studied in animal models using aged Wistar rats. Glucose infusion rates (GIR), levels of urinary albumin (UA), serum 25-hydroxyvitamin D [25-(OH)D], serum 1,25-dihydroxyvitamin D [1,25(OH)(2)D], and bone mineral density (BMD) in lumbar vertebrae and femoral bone were measured. RESULTS: GIR in obese rats decreased. A negative correlation existed between UA level and GIR in the aged obese rats, which did not exist in the normal control rats. Levels of serum 25(OH)D in all models were similar. Obese rats had lower levels of serum 1,25(OH)(2)D and BMD than normal control rats. Treating obese rats with vitamin D had no effect on levels of serum 25-(OH)D, serum 1,25(OH)(2)D, and BMD. Administration of 1alpha-(OH)D to obese rats significantly increased serum 1,25(OH)(2)D to above-normal levels and BMD to normal level. In obese rats, levels of serum 1,25(OH)(2)D and BMD in lumbar vertebrae and femoral bone were positively correlated with GIR, and the level of serum 1,25(OH)(2)D was negatively correlated with the UA level. CONCLUSIONS: In the presence of obesity, IR, renal injury, decrease in RHA and bone loss exist. IR-injured kidney accounts for a decrease in RHA, which is a precipitating factor for bone loss.