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Tapper M, McGrowder DA, Dilworth L, Soyibo A. Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients. Diseases 2021; 9:diseases9010005. [PMID: 33401560 PMCID: PMC7838907 DOI: 10.3390/diseases9010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. METHODS A cross-sectional study was conducted involving 140 CKD patients (stages 1-5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. RESULTS 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1-5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2-5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. CONCLUSIONS 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.
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Affiliation(s)
- Marlene Tapper
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
| | - Donovan A. McGrowder
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
- Correspondence:
| | - Lowell Dilworth
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
| | - Adedamola Soyibo
- Department of Medicine, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica;
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Carneiro Dias RS, José de Araújo Brito D, Milhomem Dos Santos E, Cadilhe de Oliveira Costa R, Martins Melo Fontenele A, Viana Hortegal Furtado E, Santos Lages J, Miranda Dos Santos A, Freitas Santos EJ, de Lima Carneiro ÉCR, Cruz Diniz MC, Trindade Barbosa CD, Costa de Sales Muniz A, Teixeira da Cunha França AK, Salgado Filho N, Vianna Araújo D, Bernardo-Filho M. Correlation Between Parathyroid Hormone Levels with Urinary Magnesium Excretion in Patients with Non-Dialysis Dependent Chronic Kidney Disease. Int J Nephrol Renovasc Dis 2020; 13:341-348. [PMID: 33239901 PMCID: PMC7682596 DOI: 10.2147/ijnrd.s282106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/17/2020] [Indexed: 01/01/2023] Open
Abstract
Background Disorders of mineral metabolism occur in most patients with chronic kidney disease (CKD). The aim of this work was to correlate parathyroid hormone (PTH) levels with urinary magnesium excretion in patients with non-dialysis dependent CKD. Methods Cross-sectional study. Concentrations of creatinine, magnesium, calcium, phosphate, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase (ALP) were determined in blood samples. The assessment of urinary magnesium levels was performed by means of total daily excretion and by the excretion fraction (FEMg). Results The study evaluated 163 patients with a mean age of 60.7 ± 11.7 years and 51.0% were male. In the highest quartile of PTH (>89.5pg/mL), the mean levels of FEMg and ALP were higher (p<0.05). In the unadjusted regression analysis, the following variables were related to serum PTH levels: FEMg (odds ratio (OR) = 1.12; 95% confidence intervals (CI): 1.02–1.23), calcium (OR = 0.45; 95% CI: 0.22–0.90), ALP (OR = 1.02; 95% CI: 1.00–1.03) and eGFR (OR = 0.92; 95% CI: 1.00–1.03). After an adjusted analysis, only one FEMg and ALP will remain correlated with PTH. Conclusion In patients with non-dialysis dependent CKD, FEMg and ALP were some variables that remained associated with PTH.
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Affiliation(s)
- Raimunda Sheyla Carneiro Dias
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | - Dyego José de Araújo Brito
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | | | | | - Andrea Martins Melo Fontenele
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | - Elane Viana Hortegal Furtado
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | - Joyce Santos Lages
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | | | - Elton Jonh Freitas Santos
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | | | - Maria Célia Cruz Diniz
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | - Carla Déa Trindade Barbosa
- Center for Prevention of Kidney Diseases, University Hospital of the Federal University of Maranhão, São Luís, MA, Brazil
| | | | | | | | - Denizar Vianna Araújo
- Department of Internal Medicine, University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mário Bernardo-Filho
- Laboratory of Mechanical Vibrations and Integrative Practices, Department of Biophysics and Biometrics, Institute of Biology Roberto Alcântara Gomes and Polyclinic Américo Piquet Carneiro, University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Matsumoto AK, Maes M, Michelin AP, Soares AE, Semeão LDO, Godeny P, Venturini D, Barbosa DS, Delfino VDA. Vitamin D deficiency is not associated with increased oxidative stress in chronic kidney disease pre-dialysis patients. J Bras Nefrol 2020; 42:420-428. [PMID: 32406474 PMCID: PMC7860644 DOI: 10.1590/2175-8239-jbn-2019-0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/04/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The progressive decline in 25-hydroxyvitamin D [25(OH)D] in chronic kidney disease (CKD) limits the kidney ability of synthesizing the vitamin. Vitamin D deficiency as defined by KDIGO (25(OH)D <20 ng/mL) is prevalent in CKD patients and associated to oxidative stress (OS). We studied a possible association between vitamin D deficiency and OS in pre-dialysis patients. METHODS A cross-sectional study with 206 CKD patients was carried out. Laboratory tests for 25(OH)D, 1,25(OH)2D, inflammatory markers, and OS were added to routine tests including creatinine, albumin, calcium, phosphorus, alkaline phosphatase, iPTH, glucose, hemoglobin, uric acid, total cholesterol, LDL, HDL, and triglycerides. RESULTS Vitamin D deficiency was present in 55 CKD patients and normal vitamin D levels were seen in 149 patients. There was a significant association between vitamin D and estimated glomerular filtration rate (eGRF). Homocysteine levels were best predicted by eGRF, sex, and age; high sensitivity C-reactive protein (hsCRP) by staging and BMI; nitric oxide metabolites (NOx) were increased in late disease; leptin was influenced by BMI and higher in women than man; and adiponectin levels were higher in women. CONCLUSIONS OS biomarkers were not correlated with vitamin D deficiency but increased NOx were seen in stages 4-5 CKD patients. Even though a relatively large number of CKD patients was included and a broad number of OS and inflammatory biomarkers were used in this studied we failed to find an association between vitamin D levels and eGRF. More studies are needed to evaluate the influence of vitamin D status in OS in pre-dialysis CKD patients.
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Affiliation(s)
- Andressa Keiko Matsumoto
- Universidade Estadual de Londrina, Departamento de Patologia, Análises Clínicas e Toxicológicas, Londrina, PR, Brasil
| | - Michael Maes
- Deakin University, IMPACT Research Center, Geelong, Australia
- Chulalongkorn University, Faculty of Medicine, Department of Psychiatry, Bangkok, Thailand
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, Londrina, PR, Brasil
| | - Ana Paula Michelin
- Universidade Estadual de Londrina, Departamento de Patologia, Análises Clínicas e Toxicológicas, Londrina, PR, Brasil
| | - Abel Esteves Soares
- Universidade Estadual de Londrina, Departamento de Medicina Interna, Seção de Nefrologia, Londrina, PR, Brasil
| | - Laura de Oliveira Semeão
- Universidade Estadual de Londrina, Departamento de Patologia, Análises Clínicas e Toxicológicas, Londrina, PR, Brasil
| | - Paula Godeny
- Universidade Estadual de Londrina, Departamento de Patologia, Análises Clínicas e Toxicológicas, Londrina, PR, Brasil
| | - Danielle Venturini
- Universidade Estadual de Londrina, Departamento de Patologia, Análises Clínicas e Toxicológicas, Londrina, PR, Brasil
| | - Décio Sabbatini Barbosa
- Universidade Estadual de Londrina, Departamento de Patologia, Análises Clínicas e Toxicológicas, Londrina, PR, Brasil
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Segovia-Ortí R, Bennassar AB, de Sotto-Esteban D, Cortés PS. Vitamin D status is related to severity at onset of diabetes and worse glycemic control. J Pediatr Endocrinol Metab 2020; 33:1265-1271. [PMID: 32853168 DOI: 10.1515/jpem-2020-0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
Objectives Our aim is to evaluate whether 25-hydroxyvitamin D at onset of type 1 diabetes mellitus (T1DM) would influence analytical variables of worse prognosis of the disease at the beginning and after one year of development. Methods A retrospective study of pediatric patients (0-14 years) diagnosed with T1DM with initial measurements of 25-hydroxyvitamin D was performed at Son Espases Hospital, between March 2012 and April 2019 (n=67). Results Vitamin D insufficiency was related to age, glycosylated hemoglobin, and creatinine. An improvement in glycosylated hemoglobin was found in subjects whose baseline serum 25(OH)D was >30 ng/mL. Bivariate correlation analysis adjusted by age showed a significantly positive correlation of vitamin D with pH (r=0.279), bicarbonate (r=0.338), and free levothyroxine (r=0.293). Independent variables associated with vitamin D insufficiency were age (odds ratio [OR]=1.2) and winter season (OR=10.52). Conclusion Hypovitaminosis D is related to biochemical variables showing greater severity and higher glycosylated hemoglobin at diagnosis: higher creatinine, lower free levothyroxine, pH, and bicarbonate. Unsupplemented patients with baseline deficiency showed persistently worse glycemic control vs. those with baseline repletion.
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Dall’Agnol A, Brondani LDA, Cancelier VDA, Camargo EG, Silveiro SP. Lower serum 25-hydroxyvitamin D levels are associated with impaired glomerular filtration rate in type 2 diabetes patients. Ther Adv Endocrinol Metab 2020; 11:2042018820930904. [PMID: 32782774 PMCID: PMC7385831 DOI: 10.1177/2042018820930904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND 25-Hydroxyvitamin D [25(OH)D] deficiency has been implicated as a possible risk factor for the onset and progression of diabetes kidney disease (DKD). The aim of this study was to evaluate the interaction between levels of 25(OH)D and DKD in type 2 diabetes mellitus (DM) patients. METHODS Cross-sectional design, outpatient type 2 DM. Glomerular filtration rate (GFR) was measured by 51Cr-EDTA and estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), urinary albumin excretion (UAE) by immunoturbidimetry, and 25(OH)D by chemiluminescence. Receiver operating characteristic (ROC) curve analysis and generalized linear model (Poisson robust regression estimator) were used to assess the interaction between 25(OH)D levels and renal function. RESULTS A total of 114 type 2 DM patients aged 60 ± 10 years, 49 males (43%), DM duration 22 ± 10 years, with GFR > 60 ml/min/1.73 m2 were evaluated. Patients with GFRs 60-90 (n = 50) had significantly lower 25(OH)D levels than individuals with GFRs > 90 ml/min/1.73 m2 (n = 64), respectively 40 ± 20 versus 48 ± 20 nmol/l, p = 0.027. This difference was more pronounced for older individuals (39 ± 20 versus 54 ± 23 nmol/l, respectively), and Poisson robust regression disclosed that lower 25(OH)D [Poisson regression (PR) = 0.989, confidence interval (CI): 0.978-0.999, p = 0.034], and advanced age (PR = 1.050, CI: 1.007-1.096, p = 0.023) were significantly associated with the lower GFR category, adjusted for seasons. ROC curve analysis showed that the cutoff point of 25(OH)D of 41 nmol/l was associated with lower GFR [area under the curve (AUC) = 0.694, p = 0.009]. CKD-EPI estimated GFR (eGFR) was not associated with 25(OH)D in any analysis. There was no difference in 25(OH)D levels between patients with elevated UAE as compared with normoalbuminuric ones (44 ± 21 versus 46 ± 19 nmol/l, p = 0.587). CONCLUSION Lower levels of 25(OH)D are associated with decreased GFR in patients with type 2 DM, especially in older patients, with no evidence of interaction with UAE levels.
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Affiliation(s)
- Angélica Dall’Agnol
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Letícia de Almeida Brondani
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vítor da Agostim Cancelier
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo Guimarães Camargo
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sandra Pinho Silveiro
- Endocrine Division, HCPA, Rua Ramiro Barcelos, Porto Alegre, RS Brazil
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, 2350, 4° andar, Porto Alegre, RS 90035-003, Brazil
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Jamal Shahwan M, Hassan NAG, Shaheen RA. Assessment of kidney function and associated risk factors among type 2 diabetic patients. Diabetes Metab Syndr 2019; 13:2661-2665. [PMID: 31405691 DOI: 10.1016/j.dsx.2019.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/10/2019] [Indexed: 02/01/2023]
Abstract
AIM diabetic patients are required for continuous monitoring programs hence continuous assessment of kidney function parameters is crucial. So, we aimed to determine the prevalence of Chronic Kidney Disease (CKD) and abnormal renal parameters, with poorly controlled type 2 diabetes mellitus pateints MATERIALS AND METHODS: A cross-sectional study was carried out at private health care centre. A total of 300 diabetic patients aged 18 years and above attended the clinic from February 2018 to Dec 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using (SPSS, version 23). RESULTS out of the 300 diabetes patients recruited 42% of patients with type 2 diabetes had abnormal Creatinine Serum levels and 22.3% had abnormal glomerular filtration rate (GFR). Abnormal albumin urine levels were found in 28.3% and 11.3% had abnormal creatinine in urine. Abnormal Albumin: Creatinine Ratios (Alb/Cr), were found in 23%. Of the total, 77% (n = 231) had normal Alb: Cr Ratio, 20% had risk of nephropathy and 9% had nephropathy. CONCLUSION Current study revealed a high prevalence of abnormal renal parameters in patients with type 2 diabetes Mellitus. This necessitates the need for early and universal screening of renal functions. There is also an urgent demand for measures that target tight glycaemic, Vitamin D level and life style modifications is also required to all diabetic patients to achieve target value of HbA1C ≤ 7.
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Affiliation(s)
- Moyad Jamal Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates.
| | | | - Rima Ahd Shaheen
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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Fayed A, El Nokeety MM, Heikal AA, Sadek KM, Hammad H, Abdulazim DO, Salem MM, Sharaf El Din UA. Urine albumin and serum uric acid are important determinants of serum 25 hydroxyvitamin D level in pre-dialysis chronic kidney disease patients. Ren Fail 2019; 41:540-546. [PMID: 31234687 PMCID: PMC6598477 DOI: 10.1080/0886022x.2018.1563552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Low serum 25 hydroxyvitamin D (25 OH D) is common among chronic kidney disease (CKD) patients. This cross-sectional study is looking for the different factors associated with serum 25 OH D among pre-dialysis CKD. 1624 adult stage 3–5 CKD patients were studied beside 200 normal control subjects. All candidates were tested for body mass index (BMI), estimated glomerular filtration rate (eGFR), calcium (Ca), phosphorus (P), parathormone (PTH), 25 OH D, albumin, and uric acid (UA), and urine albumin/creatinine ratio (ACR). Multivariate linear regression analysis was done to determine predictors of 25 OH D. 98.6% of CKD patients have inadequate level of 25 OH D vs 48% of normal subjects. Serum 25 OH D was significantly lower in CKD patients (mean ± S.D = 16.54 ± 5.8 vs 37.79 ± 3.58 ng/mL for CKD vs control group respectively, p < .001). Serum level of 25 OH D has significant positive correlation with Ca (r = 0.337, p < .001), and significant negative correlation with P, PTH, UA, and ACR (r = −0.440, −0. 679, −0.724, and −0.781respectively, p < .001 in all). The independent predictors of 25 OH D were Ca, P, UA, PTH, and ACR (R square = 0.7, β = −0.087, −0.226, −0.313, −0.253, and −0.33 respectively, p < .001 in all). In conclusion, pre-dialysis CKD patients frequently suffer low 25 OH D. Among the different abnormalities related to CKD, urine albumin excretion rate and UA are the most important predictors of 25 OH D in these patients.
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Affiliation(s)
- Ahmed Fayed
- a Nephrology Unit, Internal Medicine Department , School of Medicine, Cairo University , Manial , Egypt
| | - Mahmoud M El Nokeety
- a Nephrology Unit, Internal Medicine Department , School of Medicine, Cairo University , Manial , Egypt
| | - Ahmed A Heikal
- b Internal Medicine Department, School of Medicine , Cairo University , Manial , Egypt
| | - Khaled M Sadek
- a Nephrology Unit, Internal Medicine Department , School of Medicine, Cairo University , Manial , Egypt
| | - Hany Hammad
- a Nephrology Unit, Internal Medicine Department , School of Medicine, Cairo University , Manial , Egypt
| | - Dina O Abdulazim
- c Rheumatology and Rehabilitation Department, School of Medicine , Cairo University , Manial , Egypt
| | - Mona M Salem
- d Endocrinology Unit, Internal Medicine Department, School of Medicine , Cairo University , Manial , Egypt
| | - Usama A Sharaf El Din
- a Nephrology Unit, Internal Medicine Department , School of Medicine, Cairo University , Manial , Egypt
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