Relationship between the serum levels of Vitamin D and inflammatory markers in ESRD patients

Main Article Content

Abbas Etminan
Seyed Mostafa Seyed Askari
Ahmad Naghibzade Tahami
Seyed Adel Mahdi
Mina Behzadi
Mohammad Shabani

Keywords

Inflammation; 25-hydroxy vitamin D; Renal replacement; Dialysis

Abstract

Background and aim: In patients with End-stage renal disease (ESRD), 25-(OH)-Vitamin D3 deficiency is a common problem and also the inflammatory responses increase in these patients. The present study aims to evaluate the relation of 25-(OH)-Vitamin D3 with the indirect inflammatory markers in patients on hemodialysis (HD) and peritoneal dialysis (PD).


Methods: This study was done by cross-sectional method on 85 ESRD patients receiving renal replacement therapy (RRT), from one geographical area. 64 patients on HD and 21 patients on PD who were matched for age and sex were studied. Serum level of 25-(OH) Vitamin D3 was measured in each patient. ESR, CRP and the other routine blood tests were measured as well.


Results: The level of 25-OH Vitamin D3 was significantly lower in PD group in comparison to HD group (P: 0/0012, 2/70±0/10 vs 2/05±0/14). Platelet (195/40 ± 7/6 vs 265/52 ± 15/6, P: 0/001) and ESR (46/80 ± 6/89 vs 23/53 ± 1/96, P: 0/003) were significantly higher in PD group. Considering total population of the study (PD and HD), there was a significant association between ESR and serum level of 25-(OH)-Vitamin D3 (r: 0.26, P: 0.036) but no correlation was seen between 25-(OH)-Vitamin D3 and hemoglobin (Hb) or duration of dialysis. On the other hand, in patients on HD, multiple regression analysis revealed a significant relationship between duration of dialysis (P: 0.02), Hb (P: 0.01) and ESR (P: 0.001) with 25-(OH)-Vitamin D3 level. Moreover, there was a relationship between vitamin D3 levels and inflammatory markers as well.


Conclusions: The deficiency of 25-(OH)-Vitamin D3 was followed with increase of ESR as an inflammatory marker in patients on HD.


Key words: Inflammation; 25-hydroxy vitamin D; Renal replacement; Dialysis

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 181 | PDF Downloads 67

References

1. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Lai KN, Tang SC, Leung JC (2007) Mediators of inflammation and fibrosis Perit Dial Int 27 Suppl 2: S65-71The American journal of clinical nutrition. 2004;80(6):1689S-96S.
2. Dusso AS, Brown AJ, Slatopolsky E. Vitamin D. American Journal of Physiology - Renal Physiology. 2005;289(1):F8-F28.
3. Mehrotra A, Leung W-Y, Joson T. Nutritional vitamin D supplementation and health-related outcomes in hemodialysis patients: a protocol for a systematic review and meta-analysis. Systematic reviews. 2015;4(1):115.
4. Al-Badr W, Martin KJ. Vitamin D and kidney disease. Clinical Journal of the American Society of Nephrology. 2008;3(5):1555-60.
5. González EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. American journal of nephrology. 2004;24(5):503-10.
6. Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney international. 2007;72(8):1004-13.
7. Ciccone MM, Zito A, Dentamaro I, Vestito D, Scicchitano P, Iacoviello M, et al. [Vitamin D deficiency and cardiovascular diseases]. Giornale italiano di cardiologia (2006). 2015;16(1):16-20.
8. Tucker PS, Scanlan AT, Dalbo VJ. Chronic kidney disease influences multiple systems: describing the relationship between oxidative stress, inflammation, kidney damage, and concomitant disease. Oxidative medicine and cellular longevity. 2015;2015.
9. Donate-Correa J, Domínguez-Pimentel V, Méndez-Pérez M, Muros-de-Fuentes M, Mora-Fernández C, Martín-Núñez E, et al. Selective vitamin D receptor activation as anti-inflammatory target in chronic kidney disease. Mediators of inflammation. 2014;2014.
10. Lai S, Molfino A, Russo GE, Testorio M, Galani A, Innico G, et al. Cardiac, inflammatory and metabolic parameters: hemodialysis versus peritoneal dialysis. Cardiorenal medicine. 2015;5(1):20-30.
11. Dong J, Li Y-J, Yang Z-K, Xu R. Prognostic value of serum von Willebrand factor, but not soluble ICAM and VCAM, for mortality and cardiovascular events is independent of residual renal function in peritoneal dialysis patients. Peritoneal Dialysis International. 2014;34(7):706-13.
12. Kiani AN, Fang H, Magder LS, Petri M. Vitamin D deficiency does not predict progression of coronary artery calcium, carotid intima–media thickness or high-sensitivity C-reactive protein in systemic lupus erythematosus. Rheumatology. 2013;52(11):2071-6.
13. Deluca HF, Cantorna MT. Vitamin D: its role and uses in immunology. The FASEB Journal. 2001;15(14):2579-85.
14. Zhu L, Kong M, Han Y-P, Bai L, Zhang X, Chen Y, et al. Spontaneous liver fibrosis induced by long term dietary vitamin D deficiency in adult mice is related to chronic inflammation and enhanced apoptosis. Canadian journal of physiology and pharmacology. 2015;93(5):385-94.
15. Stenvinkel P, Heimbürger O, Lindholm B, Kaysen GA, Bergström J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrology Dialysis Transplantation. 2000;15(7):953-60.
16. Eleftheriadis T, Kartsios C, Liakopoulos V, Antoniadi G, Ditsa M, Papadopoulos C, et al. Does hepcidin affect erythropoiesis in hemodialysis patients? Acta haematologica. 2006;116(4):238-44.
17. Eleftheriadis T, Liakopoulos V, Antoniadi G, Kartsios C, Stefanidis I, editors. The role of hepcidin in iron homeostasis and anemia in hemodialysis patients. Seminars in dialysis; 2009: Wiley Online Library.
18. Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney international. 1999;55(2):648-58.
19. Eleftheriadis T, Kartsios C, Yiannaki E, Kazila P, Antoniadi G, Liakopoulos V, et al. Chronic inflammation and CD16+ natural killer cell zeta-chain downregulation in hemodialysis patients. Blood purification. 2008;26(4):317-21.
20. Eleftheriadis T, Liakopoulos V, Antoniadi G, Stefanidis I, Galaktidou G. Indoleamine 2, 3-dioxygenase is increased in hemodialysis patients and affects immune response to hepatitis B vaccination. Vaccine. 2011;29(12):2242-7.
21. Bilen Y, Cankaya E, Bilen N, Keles M, Erdem F, Uyanik A, et al. Peritonitis incidence was correlated with duration of peritoneal dialysis rather than leptin or neutrophil to lymphocyte (n/l) ratio in peritoneal dialysis patients. The Eurasian journal of medicine. 2014;46(3):145.
22. Lai KN, Leung JC. Inflammation in peritoneal dialysis. Nephron Clinical Practice. 2010;116(1):c11-c8.
23. Wang AY-M, Wang M, Woo J, Lam CW-K, Lui S-F, Li PK-T, et al. Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. Journal of the American Society of Nephrology. 2004;15(8):2186-94.
24. Eleftheriadis T, Antoniadi G, Liakopoulos V, Stefanidis I, Galaktidou G. Inverse association of serum 25-hydroxyvitamin D with markers of inflammation and suppression of osteoclastic activity in hemodialysis patients. Iranian journal of kidney diseases. 2012;6(2):129.
25. Esen B, Atay AE, Sahin I, Gokmen ES, Kucuk SH, Ozyurek SE, et al. The relation of serum 25-hydroxy vitamin D3 with inflammation and indirect markers of thrombotic activity in patients with end stage renal disease. Journal of Clinical & Experimental Nephrology. 2016.
26. Wang AY-M, Woo J, Lam CW-K, Wang M, Sea MM-M, Lui S-F, et al. Is a single time point C-reactive protein predictive of outcome in peritoneal dialysis patients? Journal of the American Society of Nephrology. 2003;14(7):1871-9.
27. Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxyvitamin D deficiency and inflammation and their association with hemoglobin levels in chronic kidney disease. American journal of nephrology. 2009;30(1):64-72.
28. Lindqvist PG. On the possible link between vitamin D deficiency and cardiovascular disease. Circulation. 2014;129(13):e413-e4.
29. Lai KN, Tang SC, Leung JC. Mediators of inflammation and fibrosis. Peritoneal Dialysis International. 2007;27(Supplement 2):S65-S71.