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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

Article Details

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Ashuntantang, G. E., Anakeu, A. T., Doualla, M.-S., Halle, M.-P., Kaze, F. F., Menanga, A. P., & Kingue, S. (2014). Parathyroid hormone and 25(OH) vitamin D levels in Cameroonian patients with Chronic Kidney Disease: A comparison of patients with and without diabetes. HEALTH SCIENCES AND DISEASE, 15(4). https://doi.org/10.5281/hsd.v15i4.418
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