Evaluation of the relationship of serum vitamin D levels and microalbuminuria in individuals with type 2 diabetes
Öz
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.
Anahtar Kelimeler
Kaynakça
- 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).
Tip 2 diyabetli bireylerde serum vitamin D düzeyleri ile mikroalbüminüri arasındaki ilişkinin değerlendirilmesi
Öz
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.
Anahtar Kelimeler
Kaynakça
- 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).
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2022 |
| Gönderilme Tarihi | 13 Ağustos 2021 |
| Yayımlandığı Sayı | Yıl 2022Cilt: 61 Sayı: 1 |
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