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Tip 2 diyabetli bireylerde serum vitamin D düzeyleri ile mikroalbüminüri arasındaki ilişkinin değerlendirilmesi

Year 2022, Volume 61, Issue 1, 73 - 79, 15.03.2022
https://doi.org/10.19161/etd.1086114

Abstract

Amaç: D vitamin eksikliği, birçok çalışmada diyabet gelişimi için önemli bir risk faktörü olarak gösterilmiştir. Tip 2 diabetes mellitus’lu hastalarında, D vitamin eksikliği sık görülmektedir. Bu çalışmada Tip 2 diyabetli bireylerde serum vitamin D düzeyleri ile mikroalbüminüri arasındaki ilişkiyi araştırmayı amaçladık.

Gereç ve Yöntemler: Tip 2 diabetes mellitus tanısı ile izlenen 18 ile 75 yaş aralığında 177 kadın, 205 erkek toplam 382 hasta çalışmaya alındı. Hastaların, D vitamin, idrar mikroalbumin/kreatinin, homosistein ve biyokimyasal parametreleri değerlendirildi.

Bulgular: Diyabetik nefropatisi olan grupta 182 hasta ve diyabetik nefropati olmayan grupta 200 hasta mevcuttu. Nefropati olan grupta D vitamin ortalaması:11.8 ng/ml, nefropati olmayan grupta D vitamin ortalaması:14,4 ng/ml, iki grup arasındaki fark istatiksel olarak anlamlıydı. Pearson kolerasyon analizinde D vitamin ile mikroalbuminüri (p:0,028, r:-0,87) arasında güçlü negatif kolerasyon saptandı. Logistik regresyon analizde nefropati gelişiminde D vitamin eksikliğinin etkisi anlamlı saptandı (p:0,000, OR:1,060, % 95 CI 1,028-1,93). D vitamini eksikliği açısından değerlendirildiğinde Hba1c ile anlamlı ilişki bulunmazken (p:0,258, OR:934, %95 CI 0,830-1,051), mikroalbuminüri ile anlamlı ilişki saptandı (p:0,040, OR:996, %95 CI 0,993-1,000). Nefropati olan grupta homosistein düzeyi 21,8 ± 1,5 μmol/L, nefropati olmayan grupta homosistein düzeyi 14,5 ± 2,5 μmol/L, iki grup arasındaki fark istatiksel olarak anlamlıydı (P:0,017). D vitamin ile homosistein (p:0,018, r:-0,910) arasında güçlü negatif kolerasyon mevcuttu.

Sonuç: Çalışmamızın sonuçlarına göre D vitamin eksikliğinin mikroalbuminüri ve hiperhomosisteinemiye neden olarak diyabetik nefropatiyi artırdığını söyleyebiliriz.

References

  • Holick MF. Medical progress: Vitamin D deficiency. N Engl J Med. 2007 Oct 9; 357 (3): 266–81.
  • Muszkat P, Camargo MBR, Griz LHM, Lazaretti-Castro M. Evidências das ações não esqueléticas da vitamina D. Vol. 54, Arquivos Brasileiros de Endocrinologia e Metabologia. Arq Bras Endocrinol Metabol; 2010. p. 110–7.
  • Haddad JG, Matsuoka LY, Hollis BW, Hu YZ, Wortsman J. Human plasma transport of vitamin D after its endogenous synthesis. J Clin Invest. 1993; 91 (6): 2552–5.
  • Ahmadieh H, Azar ST, Lakkis N, Arabi A. Hypovitaminosis D in Patients with Type 2 Diabetes Mellitus: A Relation to Disease Control and Complications. ISRN Endocrinol. 2013 Oct 22; 2013: 1–7.
  • Chertow BS, Sivitz WI, Baranetsky NG, Clark SA, Waite A, Deluca HF. Cellular mechanisms of insulin release: The effects of vitamin D deficiency and repletion on rat insulin secretion. Endocrinology. 1983; 113 (4): 1511–8.
  • Alcubierre N, Valls J, Rubinat E, et al. Vitamin D deficiency is associated with the presence and severity of diabetic retinopathy in type 2 diabetes mellitus. J Diabetes Res. 2015; 2015: 374178.
  • Duranton F, Rodriguez-Ortiz ME, Duny Y, Rodriguez M, Daurès JP, Argilés A. Vitamin D treatment and mortality in chronic kidney disease: A systematic review and meta-analysis. Am J Nephrol. 2013 Apr; 37 (3): 239–48.
  • Bonakdaran S, Hami M, Hatefi A. The effects of calcitriol on albuminuria in patients with type-2 diabetes mellitus. Saudi J Kidney Dis Transpl. 2012; 23 (6): 1215–20.
  • Holick MF. Vitamin D and bone health. In: Journal of Nutrition. J Nutr; 1996. 1159S-64S
  • Maclaughlin JA, Anderson RR, Holick MF. Spectral character of sunlight modulates photosynthesis of previtamin D3 and its photoisomers in human skin. Science (80-). 1982; 216 (4549): 1001–3.
  • Tai K, Need AG, Horowitz M, Chapman IM. Vitamin D, glucose, insulin, and insulin sensitivity. Vol. 24, Nutrition. Nutrition; 2008. p. 279–85.
  • Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: A birth-cohort study. Lancet. 2001 Nov 3; 358 (9292): 1500–3.
  • Pittas AG, Lau J, Hu FB, Dawson-Hughes B. Review: The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. Vol. 92, Journal of Clinical Endocrinology and Metabolism. J Clin Endocrinol Metab; 2007. p. 2017–29.
  • Basat S, Sivritepe R, Ortaboz D, et al. The relationship between vitamin D level and erectile dysfunction in patients with type 2 diabetes mellitus. Aging Male. 2018 Apr 3; 21 (2): 111–5.
  • Herrmann M, Sullivan DR, Veillard AS, et al. Serum 25-Hydroxyvitamin D: A predictor of macrovascular and microvascular complications in patients with type 2 diabetes. Diabetes Care. 2015 Mar 1; 38 (3): 521–8.
  • Urea-Torres P, Metzger M, Haymann JP, et al. Association of kidney function, vitamin D deficiency, and circulating markers of mineral and bone disorders in CKD. Am J Kidney Dis. 2011 Oct; 58 (4): 544–53.
  • Sánchez-Hernández RM, García-Cantón C, Lorenzo DL, et al. The specific relationship between vitamin D deficiency and diabetic nephropathy among patients with advanced chronic kidney disease: A cross-sectional study in Gran Canaria, Spain. Clin Nephrol. 2015 Apr 1;83 (4): 218–24.
  • Joergensen C, Hovind P, Schmedes A, Parving HH, Rossing P. Vitamin D levels, microvascular complications, and mortality in type 1 diabetes. Diabetes Care. 2011 May; 34 (5): 1081–5.
  • Zhang Z, Zhang Y, Ning G, Deb DK, Kong J, Yan CL. Combination therapy with AT1 blocker and vitamin D analog markedly ameliorates diabetic nephropathy: Blockade of compensatory renin increase. Proc Natl Acad Sci U S A. 2008 Oct 14; 105 (41):15896–901.
  • Izquierdo MJ, Cavia M, Muñiz P, et al. Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients. BMC Nephrol. 2012;13.
  • Ucak S, Sevim E, Ersoy D, Sivritepe R, Basat O, Atay S. Evaluation of the relationship between microalbuminuria and 25-(OH) vitamin D levels in patients with type 2 diabetes mellitus. Aging Male. 2019 Apr 3; 22 (2): 116–20.
  • Chrysant SG, Chrysant GS. The current status of homocysteine as a risk factor for cardiovascular disease: a mini review. Vol. 16, Expert Review of Cardiovascular Therapy. Expert Rev Cardiovasc Ther; 2018. p. 559–65
  • Huang X, Li Y, Li P, et al. Association between percent decline in serum total homocysteine and risk of first stroke. Neurology. 2017; 89 (20): 2101–7.
  • Kuang ZM, Wang Y, Feng SJ, Jiang L, Cheng WL. Association between plasma homocysteine and microalbuminuria in untreated patients with essential hypertension: A case-control study. Kidney Blood Press Res. 2017;42(6):1303–11.
  • Chico A, Pérez A, Córdoba A, et al. Plasma homocysteine is related to albumin excretion rate in patients with diabetes mellitus: A new link between diabetic nephropathy and cardiovascular disease? Diabetologia. 1998; 41 (6): 684–93.
  • Upchurch GR, Welche GN, Fabian AJ, et al. Homocyst(e)ine decreases bioavailable nitric oxide by a mechanism involving glutathione peroxidase. J Biol Chem. 1997 Jul 4; 272 (27): 17012–7.
  • Mao X, Xing X, Xu R, et al. Folic Acid and Vitamins D and B12 Correlate with Homocysteine in Chinese Patients with Type-2 Diabetes Mellitus, Hypertension, or Cardiovascular Disease. Med (United States). 2016 Feb 1; 95 (6).

Evaluation of the relationship of serum vitamin D levels and microalbuminuria in individuals with type 2 diabetes

Year 2022, Volume 61, Issue 1, 73 - 79, 15.03.2022
https://doi.org/10.19161/etd.1086114

Abstract

Aim: Vitamin D deficiency has been shown as a risk factor for diabetes mellitus in many studies. We aimed to investigate the relationship between serum vitamin D levels and microalbuminuria in individuals with type 2 diabetes.

Material and Methods: A total of 382 patients, 177 females and 205 males, between the ages of 18 and 75 with a diagnosis of type 2 diabetes mellitus were included in the study. Vitamin D, homocysteine, microalbumin/creatinine and biochemical parameters were evaluated.

Results: There were 182 patients in the group with diabetes nephropathy and 200 patients in the group without nephropathy. Mean vitamin D levels were significantly higher in the group without nephropathy (nephropathy group 11.8 ng/ml, group without nephropathy 14.4 ng/ml p: 0.001). Negative correlation was observed between vitamin D and microalbuminuria in Pearson correlation analysis (p: 0.028, r:-0.87). In logistic regression analysis, the effect of vitamin D deficiency on the development of nephropathy was found to be significant(p:0.000, OR:1.060, %95 CI-1.028-1.93).When evaluated in terms of vitamin D deficiency, there was no significant relationship with Hba1c(p:0.258, OR:934, 95%, CI-0.830-1.051), while a significant relationship was found with microalbuminuria(p:0.040, OR: 996, 95% CI-0.993-1.000).Homocysteine level was 21.8 ± 1.5 μmol/L in the group with nephropathy, 14.5 ± 2.5 μmol/L in the group without nephropathy, and the difference between the two groups was statistically significant (P:0.017).

Conclusion: Vitamin D deficiency worsens diabetic nephropathy by causing microalbuminuria and hyperhomocysteinemia.

References

  • Holick MF. Medical progress: Vitamin D deficiency. N Engl J Med. 2007 Oct 9; 357 (3): 266–81.
  • Muszkat P, Camargo MBR, Griz LHM, Lazaretti-Castro M. Evidências das ações não esqueléticas da vitamina D. Vol. 54, Arquivos Brasileiros de Endocrinologia e Metabologia. Arq Bras Endocrinol Metabol; 2010. p. 110–7.
  • Haddad JG, Matsuoka LY, Hollis BW, Hu YZ, Wortsman J. Human plasma transport of vitamin D after its endogenous synthesis. J Clin Invest. 1993; 91 (6): 2552–5.
  • Ahmadieh H, Azar ST, Lakkis N, Arabi A. Hypovitaminosis D in Patients with Type 2 Diabetes Mellitus: A Relation to Disease Control and Complications. ISRN Endocrinol. 2013 Oct 22; 2013: 1–7.
  • Chertow BS, Sivitz WI, Baranetsky NG, Clark SA, Waite A, Deluca HF. Cellular mechanisms of insulin release: The effects of vitamin D deficiency and repletion on rat insulin secretion. Endocrinology. 1983; 113 (4): 1511–8.
  • Alcubierre N, Valls J, Rubinat E, et al. Vitamin D deficiency is associated with the presence and severity of diabetic retinopathy in type 2 diabetes mellitus. J Diabetes Res. 2015; 2015: 374178.
  • Duranton F, Rodriguez-Ortiz ME, Duny Y, Rodriguez M, Daurès JP, Argilés A. Vitamin D treatment and mortality in chronic kidney disease: A systematic review and meta-analysis. Am J Nephrol. 2013 Apr; 37 (3): 239–48.
  • Bonakdaran S, Hami M, Hatefi A. The effects of calcitriol on albuminuria in patients with type-2 diabetes mellitus. Saudi J Kidney Dis Transpl. 2012; 23 (6): 1215–20.
  • Holick MF. Vitamin D and bone health. In: Journal of Nutrition. J Nutr; 1996. 1159S-64S
  • Maclaughlin JA, Anderson RR, Holick MF. Spectral character of sunlight modulates photosynthesis of previtamin D3 and its photoisomers in human skin. Science (80-). 1982; 216 (4549): 1001–3.
  • Tai K, Need AG, Horowitz M, Chapman IM. Vitamin D, glucose, insulin, and insulin sensitivity. Vol. 24, Nutrition. Nutrition; 2008. p. 279–85.
  • Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: A birth-cohort study. Lancet. 2001 Nov 3; 358 (9292): 1500–3.
  • Pittas AG, Lau J, Hu FB, Dawson-Hughes B. Review: The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. Vol. 92, Journal of Clinical Endocrinology and Metabolism. J Clin Endocrinol Metab; 2007. p. 2017–29.
  • Basat S, Sivritepe R, Ortaboz D, et al. The relationship between vitamin D level and erectile dysfunction in patients with type 2 diabetes mellitus. Aging Male. 2018 Apr 3; 21 (2): 111–5.
  • Herrmann M, Sullivan DR, Veillard AS, et al. Serum 25-Hydroxyvitamin D: A predictor of macrovascular and microvascular complications in patients with type 2 diabetes. Diabetes Care. 2015 Mar 1; 38 (3): 521–8.
  • Urea-Torres P, Metzger M, Haymann JP, et al. Association of kidney function, vitamin D deficiency, and circulating markers of mineral and bone disorders in CKD. Am J Kidney Dis. 2011 Oct; 58 (4): 544–53.
  • Sánchez-Hernández RM, García-Cantón C, Lorenzo DL, et al. The specific relationship between vitamin D deficiency and diabetic nephropathy among patients with advanced chronic kidney disease: A cross-sectional study in Gran Canaria, Spain. Clin Nephrol. 2015 Apr 1;83 (4): 218–24.
  • Joergensen C, Hovind P, Schmedes A, Parving HH, Rossing P. Vitamin D levels, microvascular complications, and mortality in type 1 diabetes. Diabetes Care. 2011 May; 34 (5): 1081–5.
  • Zhang Z, Zhang Y, Ning G, Deb DK, Kong J, Yan CL. Combination therapy with AT1 blocker and vitamin D analog markedly ameliorates diabetic nephropathy: Blockade of compensatory renin increase. Proc Natl Acad Sci U S A. 2008 Oct 14; 105 (41):15896–901.
  • Izquierdo MJ, Cavia M, Muñiz P, et al. Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients. BMC Nephrol. 2012;13.
  • Ucak S, Sevim E, Ersoy D, Sivritepe R, Basat O, Atay S. Evaluation of the relationship between microalbuminuria and 25-(OH) vitamin D levels in patients with type 2 diabetes mellitus. Aging Male. 2019 Apr 3; 22 (2): 116–20.
  • Chrysant SG, Chrysant GS. The current status of homocysteine as a risk factor for cardiovascular disease: a mini review. Vol. 16, Expert Review of Cardiovascular Therapy. Expert Rev Cardiovasc Ther; 2018. p. 559–65
  • Huang X, Li Y, Li P, et al. Association between percent decline in serum total homocysteine and risk of first stroke. Neurology. 2017; 89 (20): 2101–7.
  • Kuang ZM, Wang Y, Feng SJ, Jiang L, Cheng WL. Association between plasma homocysteine and microalbuminuria in untreated patients with essential hypertension: A case-control study. Kidney Blood Press Res. 2017;42(6):1303–11.
  • Chico A, Pérez A, Córdoba A, et al. Plasma homocysteine is related to albumin excretion rate in patients with diabetes mellitus: A new link between diabetic nephropathy and cardiovascular disease? Diabetologia. 1998; 41 (6): 684–93.
  • Upchurch GR, Welche GN, Fabian AJ, et al. Homocyst(e)ine decreases bioavailable nitric oxide by a mechanism involving glutathione peroxidase. J Biol Chem. 1997 Jul 4; 272 (27): 17012–7.
  • Mao X, Xing X, Xu R, et al. Folic Acid and Vitamins D and B12 Correlate with Homocysteine in Chinese Patients with Type-2 Diabetes Mellitus, Hypertension, or Cardiovascular Disease. Med (United States). 2016 Feb 1; 95 (6).

Details

Primary Language Turkish
Subjects Health Care Sciences and Services
Journal Section Research Articles
Authors

Emine KARTAL BAYKAN This is me (Primary Author)
Erzurum Bölge Eğitim ve Araştırma Hastanesi, Endokrinoloji ve Metabolizma Hastalıkları, Erzurum, Türkiye
0000-0001-6813-883X
Türkiye


Yılmaz YILDIRIMER This is me
Erzurum Bölge Eğitim ve Araştırma Hastanesi, İç Hastalıkları Anabilim Dalı, Erzurum, Türkiye
0000-0001-7470-1721
Türkiye


İbrahim DURMAZATAR This is me
Erzurum Bölge Eğitim ve Araştırma Hastanesi, İç Hastalıkları Anabilim Dalı, Erzurum, Türkiye
0000-0002-6201-9685
Türkiye

Publication Date March 15, 2022
Application Date August 13, 2021
Acceptance Date November 4, 2021
Published in Issue Year 2022, Volume 61, Issue 1

Cite

Vancouver Kartal Baykan E. , Yıldırımer Y. , Durmazatar İ. Tip 2 diyabetli bireylerde serum vitamin D düzeyleri ile mikroalbüminüri arasındaki ilişkinin değerlendirilmesi. Ege Tıp Dergisi. 2022; 61(1): 73-79.