Parathyroid hormone and 25(OH) vitamin D levels in Cameroonian patients with Chronic Kidney Disease: A comparison of patients with and without diabetes

Gloria Enow Ashuntantang, Aurelien T. Anakeu, Marie-Solange Doualla, Marie-Patrice Halle, Francois F. Kaze, Alain P Menanga, Samuel Kingue

Abstract


Background: Chronic kidney disease (CKD) patients with diabetes show lower levels of 25-hydoxyvitamin D3 (25(OH)D) and parathormone (PTH) compared to non-diabetics in temperate climates. Our aim was to investigate if this association exists in CKD populations in tropical climates.

Methods: This cross-sectional study compared fasting serum levels of 25(OH)D and intact PTH in unselected patients with and without diabetes treated for CKD stages 3-5D in 3 nephrology facilities in Cameroon from January-March 2013. Stepwise multinomial logistic regression analysis was used to determine factors associated with 25(OH)D deficiency in non-dialyzed patients. Statistical significance was set at a P value≤0.05

Results:   Of 112 patients, 45 were diabetics (24 dialyzed) and 67 non-diabetics (51 dialyzed). Diabetics were older (p<0.001), had higher BMIs (p =0.004), more males (p=0.042); received less phosphate binders (p=0.031) and more oral vitamin D3(p=0.007). Mean dialysis vintage was 39±35.6 months (n=75). Mean serum calcium, phosphorus and albumin were 9.5±0.9mg/dl, 4.7±0.23mg/dl and 3.8±0.6mg/dl respectively and comparable in the 2 groups. Diabetics had significantly lower median (25th-75th percentiles) PTH [234(124-405) vs. 475(219-970)pg/ml p=0.021] and 25(OH)D levels [20.2(10.4-32.8) vs. 28.4(20.8-42.6)ng/ml p=0.031]. Vitamin D deficiency (25(OH)D≤15ng/ml) was more prevalent in diabetics (40.0% vs. 14.9%, p=0.003), and this was independently associated with vitamin D deficiency in non-dialyzed patients (OR =7.51, 95%CI 1.71-33.3, p=0.007).

Conclusion: Our findings confirm reports from temperate zones and suggest a need for regular monitoring of PTH and 25(OH)D levels especially in non-dialyzed diabetics with CKD in tropical regions.

Key words: Parathormone- 25(OH)D- vitamin D deficiency- diabetes- CKD   

                                                                              

 

                                                           

 

Résume

Contexte: Les diabétiques atteinte de maladie rénale chronique (MRC) présentent un faible taux de 25-hydoxyvitamin D3 [25(OH)D] et parathormone (PTH) comparé aux non-diabétiques dans les régions tempérées. Le but de ce travail était de vérifier cette hypothèse dans une population similaire sous les tropiques.

Méthodes: Il s’agissait d’une étude transversale réalisée de Janvier à Mars 2013 dans 3 unités de néphrologie du Cameroun, comparant les taux sanguins de 25(OH)D et PTH chez les patients diabétiques et non-diabétiques avec une MRC stades 3-5D. Le modèle de régression logistique multinomial étés utilise pour rechercher les facteurs associé au déficit en vitamine D chez les non kit5dialysés.

Résultats:   Etaient inclus 112 patients (75 hémodialysés) dont 45 diabétiques (24 hémodialysés). L’âge avancé, le sexe masculin, l’index de masse corporelle élevé, la sous- utilisation des chélateurs de phosphore et la supplémentation en vitamine D étaient associés au diabète (tous p<0,042). Les moyennes de la calcémie (9,5±0,9mg/dl), la phosphorémie (4,7±0,23mg/dl) et l’albuminémie (3,8±0,6mg/dl) étaient comparables dans les 2 groupes. La médiane (25-75 percentiles) de PTH [234(124-405) vs. 475(219-970)pg/ml p=0,021] et 25(OH)D [20,2(10,4-32,8) vs. 28,4(20,8-42,6)ng/ml p=0,031] était plus basse chez les diabétiques qui présentaient une prévalence élevée de déficit en vitamine D (40,0% vs. 14,9%, p=0,003). Le diabète était l’unique facteur associé au déficit en vitamine D chez les non dialysés (OR =7,51, 95%CI 1,71-33,3, p=0,007).

Conclusion: Nos résultats sont similaires aux données des régions tempérées et suggèrent une surveillance régulière des taux sanguins de PTH et 25(OH)D particulièrement chez les diabétiques non-hémodialysés sous les tropiques.

Mots clés: Parathormone - 25(OH) vitamin D - Déficit vitamine D – diabète - MRC     


Keywords


Parathormone- 25(OH)D- vitamin D deficiency- diabetes- CKD

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References

de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. TEmporal trends in the prevalence of diabetic kidney disease in the united states. JAMA. 2011; 305(24):2532–9.

Keith DS, Nichols GA, Gullion CM, Brown J, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004 22; 164(6):659–63.

US Renal Data System, USRDS 2010 Annual Data Report: Atlas of chronic kidney disease and End stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD,2010

Kidney Disease: Improving Global Outcomes(KDIGO) CKD-MBD Work Group.. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2009; 76(suppl 113):S1-130.

Schwarz S, Trivedi BK, Kalantar-Zadeh K, Kovesdy CP. Association of disorders in mineral metabolism with progression of chronic kidney disease. Clin J Am Soc Nephrol. 2006; 1(4):825–31.

Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, et al. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005; 16(2):520–8.

Ravani P, Malberti F, Tripepi G, Pecchini P, Cutrupi S, Pizzini P, et al. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int. 2009;75(1):88–95.

Andress DL, Hercz G, Kopp JB, Endres DB, Norris KC, Coburn JW, et al. Bone histomorphometry of renal osteodystrophy in diabetic patients. J Bone Miner Res. 1987;2(6):525–31.

Vincenti F, Arnaud SB, Recker R, Genant H, Amend Jr WJ, Feduska NJ, et al. Parathyroid and bone response of the diabetic patient to uremia. Kidney Int. 1984; 25(4):677-682.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.

Fajtova VT, Sayegh MH, Hickey N, Aliabadi P, Lazarus JM, LeBoff MS. Intact parathyroid hormone levels in renal insufficiency. Calcif Tissue Int. 1995;57(5):329–35.

Ishimura E, Nishizawa Y, Inaba M, Matsumoto N, Emoto M, Kawagishi T, et al. Serum levels of 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D, and 25-hydroxyvitamin D in nondialyzed patients with chronic renal failure. Kidney Int. 1999; 55(3):1019–27.

Wahl P, Xie H, Scialla J, Anderson CAM, Bellovich K, Brecklin C, et al. Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease. Diabetes Care. 2012;35(5):994–1001.

Ghosh B, Brojen T, Banerjee S, Singh N, Singh S, Sharma OP, et al. The high prevalence of chronic kidney disease-mineral bone disorders: A hospital-based cross-sectional study. Indian J Nephrol. 2012 ;22(4):285–91.

Martinez I, Saracho R, Moina I, Montenegro J, Llach F. Is there a lesser hyperparathyroidism in diabetic patients with chronic renal failure? Nephrol Dial Transplant. 1998;13(suppl 3):9–11.

Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005;67(3):1179–87.

Okuno S, Inaba M. [Bone abnormalities in diabetic hemodialysis patients]. Clin Calcium. 2006; 16(8):1344–50.

Sugimoto T, Ritter C, Morrissey J, Hayes C, Slatopolsky E. Effects of high concentrations of glucose on PTH secretion in parathyroid cells. Kidney Int. 1990; 37(6):1522–7.

Inaba M, Okuno S, Nagasue K, Otoshi T, Kurioka Y, Maekawa K, et al. Impaired secretion of parathyroid hormone is coherent to diabetic hemodialyzed patients. Am J Kidney Dis. 2001; 38(4 Suppl 1):S139–142.

Massry SG, Coburn JW, Lee DB, Jowsey J, Kleeman CR. Skeletal resistance to parathyroid hormone in renal failure. Studies in 105 human subjects. Ann Intern Med. 1973; 78(3):357–64.

Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab. 2001; 86(1):32–8.

Forsén L, Meyer HE, Midthjell K, Edna TH. Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trøndelag Health Survey. Diabetologia. 1999; 42(8):920–5.

Rodríguez Villarreal I, Ortega O, Gallar P, Sánchez M, Callejas R, Gracia C, et al. [Clinical and biochemical characteristics of predialysis patients in terms of 25 hydroxy vitamin D levels]. Nefrologia. 2011;31(2):185–91.

Petchey WG, Johnson DW, Hawley CM, Isbel NM. Predictors of vitamin D status in predialysis chronic kidney disease patients: a cross-sectional analysis in a high ultraviolet climate. J Ren Nutr 2012 ;22(4):400–8.

Jean G, Vanel T, TERRAT J-C, Chazot C. Prevention of secondary hyperparathyroidism in hemodialysis patients: the key role of native vitamin D supplementation. Hemodial Int. 2010;14(4):486–91.

Chang JH, Ro H, Kim S, Lee HH, Chung W, Jung JY. Study on the relationship between serum 25-hydroxyvitamin D levels and vascular calcification in hemodialysis patients with consideration of seasonal variation in vitamin D levels. Atherosclerosis. 2012; 220(2):563–8.

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 Int. 2007;72(8):1004–13.

Agarwal R. Vitamin D, proteinuria, diabetic nephropathy, and progression of CKD. Clin J Am Soc Nephrol. 2009;4(9):1523–8.

Thrailkill KM, Jo C-H, Cockrell GE, Moreau CS, Fowlkes JL. Enhanced excretion of vitamin D binding protein in type 1 diabetes: a role in vitamin D deficiency? J Clin Endocrinol Metab. 2011;96(1):142–9.

Cuppari L, Garcia-Lopes MG. Hypovitaminosis D in chronic kidney disease patients: prevalence and treatment. J Ren Nutr. 2009;19(1):38–43.

LaClair RE, Hellman RN, Karp SL, Kraus M, Ofner S, Li Q, et al. Prevalence of calcidiol deficiency in CKD: a cross-sectional study across latitudes in the United States. Am J Kidney Dis. 2005;45(6):1026–33.

Chonchol M, Scragg R. 25-Hydroxyvitamin D, insulin resistance, and kidney function in the Third National Health and Nutrition Examination Survey. Kidney Int. 2006;71(2):134–9.

Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol [Internet]. 2009 [cited 2014 Jul 21];2010. Available from: http://www.hindawi.com/journals/ije/aip/351385/


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