Efekat vitamina D na proteinuriju, lipidni status, glikoregulaciju i C-reaktivni protein kod bolesnika sa dijabetes melitusom tip 2

  • Marijana Petrović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
  • Tamara Dragović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Stanko Petrović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Katarina Obrenčević Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
  • Nemanja Rančić Military Medical Academy, Clinic for Endocrinology, Belgrade, Serbia
  • Tatjana Djurašinović Military Medical Academy, Institute of Medical Biochemistry, Belgrade, Serbia
  • Dejan Petrović Clinical Center Kragujevac, Department of Internal Medicine, Kragujevac, Serbia
  • Ljiljana Ignjatović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
  • Violeta Rabrenović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
  • Nemanja Nenezić Military Medical Academy, Clinic for Endocrinology, Belgrade, Serbia
  • Dejan Marinković Military Medical Academy, Clinic for Endocrinology, Belgrade, Serbia
  • Djoko Maksić Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP180525113P
Ključne reči: c-reaktivni protein, holesterol, dijabetes melitus, tip-2, dijabetičke nefropatije, hemoglobin a, glikozilovan, vitamin d, lečenje, ishod, proteinurija, trigliceridi

Sažetak


Uvod/Cilj. Nedostatak vitamina D je često prisutan kod bolesnika sa dijabetes melitusom (DM) tip 2 i može biti faktor rizika od brže progresije dijabetesne nefropatije i veće incidencije kardiovaskularnih događaja. Cilj studije bio je da se ispita uticaj supstitucije vitamina D na proteinuriju, holesterol, trigliceride, C-reaktivni protein (CRP) i hemoglobin A1c kod bolesnika sa DM tip 2 i nedostatkom vitamina D. Metode. Prospektivnom, kohortnom studijom obuhvaćeno je 90 bolesnika sa DM tip 2 i nedostatkom (insuficijencija/deficijencija) vitamina D svrstanih u tri grupe po 30 bolesnika: I – sa normalnom proteinurijom, II – sa mikroproteinurijom i III – sa makroproteinurijom. Sprovedena je šestomesečna nadoknada vitamina D holekalciferol kapima: tokom prva dva meseca sa 20 000 i.j. dva puta nedeljno, a zatim, je kod bolesnika kod kojih je nivo vitamina D ostao snižen nastavljeno sa istom dozom još četiri meseca. Kod bolesnika kod kojih se nivo vitamina D normalizovao, nastavljeno je sa 5 000 i.j. dva puta nedeljno. Na početku i na kraju ispitivanja meren je nivo uree, kreatinina, jutarnje glikemije, kalcijuma, fosfora, holesterola, triglicerida, CRP, hemoglobina A1c, intaktnog paratireoidnog hormona, 24-časovne proteinurije i klirensa kreatinina. Zbog eventualne korekcije doze holekalciferola vrednosti kalcijuma, fosfora i vitamina D proverene su i dva meseca posle započinjanja supstitucije. Rezultati. Najniži nivo vitamina D pre terapije imali su bolesnici u grupi sa makroproteinurijom, dok je na kraju ispitivanja utvrđen statistički značajno povišen nivo vitamina D, u sve tri grupe. Nakon šestomesečne primene vitamina D, postignuto je statistički značajno sniženje nivoa 24-časovne proteinurije, holesterola, triglicerida i hemoglobin A1c u sve tri ispitivane grupe, a CRP u grupi sa normalnom proteinurijom i mikroproteinurijom. Statistički značajna negativna korelacija između vitamina D i 24-časovne proteinurije, holesterola i CRP dokazana je u grupi sa makroproteinurijom. Statistički značajna negativna korelacija dokazana je između vitamina D i HBA1c u grupi sa normalnom proteinurijom i vitamina D i CRP u grupi sa miroproteinurijom. Zaključak. Supstitucija vitamina D visokim dozama holekalciferola i njegova preventivna primena kod bolesnika sa DM tip 2 (sa ili bez proteinurije) snižava holesterol, trigliceride, proteinuriju, CRP i hemoglobin A1c.

Reference

Diabetes Federation. IDF Diabetes Atlas. 6th ed. Brussels, Belgium: International Diabetes Federation; 2013.

International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Brussels, Belgium: International Diabetes Federation; 2015.

United States Renal Data System. 2016 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. Bethesda, MD: National Institutes of Health, National Insti-tute of Diabetes and Digestive and Kidney Diseases; 2016.

Lin YC, Chang YH, Yang SY, Wu KD, Chu TS. Update of pathophysiology and management of diabetic kidney disease. J Formos Med Assoc 2018; 117(8): 662–75.

Fried LF, Emanuele N, Zhang JH, Brophy M, Conner TA, Duck-worth W, et al. Combined angiotensin inhibition for the treat-ment of diabetic nephropathy. N Engl J Med 2013; 369(20): 1892–903.

Parving HH, Brenner BM, McMurray JJ, de Zeeuw D, Haffner SM, Solomon SD, et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012; 367(23): 2204–13.

Novak JE, Yee J. Diabetes and the Kidney: Sweet Dreams. Adv Chronic Kidney Dis 2018; 25(2): 115-8.

Navarro-González JF, Mora-Fernández C, Muros de Fuentes M, Chahin J, Méndez ML, Gallego E, et al. Effect of pentoxifylline on renal function and urinary albumin excretion in patients with diabetic kidney disease: the PREDIAN trial. J Am Soc Nephrol 2015; 26(1): 220–9.

Bakris GL, Agarwal R, Chan JC, Cooper ME, Gansevoort RT, Haller H, et al. Effect of Finerenone on Albuminuria in Pa-tients With Diabetic Nephropathy: A Randomized Clinical Trial. JAMA 2015; 314(9): 884–94.

Kouroumichakis I, Papanas N, Zarogoulidis P, Liakopoulos V, Maltezos E, Mikhailidis DP. Fibrates: therapeutic potential for diabetic nephropathy? Eur J Intern Med 2012; 23(4): 309–16.

Goicoechea M, Garcia de Vinuesa S, Verdalles U, Verde E, Macias N, Santos A, et al. Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial. Am J Kidney Dis 2015; 65(4): 543–9.

Momeni A, Behradmanesh MS, Kheiri S, Karami Horestani M. Evaluation of spironolactone plus hydrochlorothiazide in re-ducing proteinuria in type 2 diabetic nephropathy. J Renin Angiotensin Aldosterone Syst 2015; 16(1): 113–8.

Mitri J, Pittas AG. Vitamin D and diabetes. Endocrinol Metab Clin North Am 2014; 43(1): 205–32.

Guan X, Yang H, Zhang W, Wang H, Liao L. Vitamin D recep-tor and its protective role in diabetic nephropathy. Chin Med J (Engl) 2014; 127(2): 365–9.

Zhang Z, Sun L, Wang Y, Ning G, Minto AW, Kong J, et al. Renoprotective role of the vitamin D receptor in diabetic nephropathy. Kidney Int 2008; 73(2): 163–71.

Ito I, Waku T, Aoki M, Abe R, Nagai Y, Watanabe T, et al. A nonclassical vitamin D receptor pathway suppresses renal fi-brosis. J Clin Invest 2013; 123(11): 4579–94.

Liyanage P, Lekamwasam S, Weerarathna TP, Liyanage C. Effect of Vitamin D therapy on urinary albumin excretion, renal functions, and plasma renin among patients with diabetic nephropathy: A randomized, double-blind clinical trial. J Postgrad Med 2018; 64(1): 10–5.

Xiao X, Wang Y, Hou Y, Han F, Ren J, Hu Z. Vitamin D defi-ciency and related risk factors in patients with diabetic nephropathy. J Int Med Res 2016; 44(3): 673–84.

Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev 2015; 16(4): 341–9.

Gonzalez-Parra E, Rojas-Rivera J, Tuñón J, Praga M, Ortiz A, Eg-ido J. Vitamin D receptor activation and cardiovascular dis-ease. Nephrol Dial Transplant 2012; 27 Suppl 4: iv17–21.

Humalda JK, Goldsmith DJ, Thadhani R, de Borst MH. Vitamin D analogues to target residual proteinuria: potential impact on cardiorenal outcomes. Nephrol Dial Transplant 2015; 30(12): 1988–94.

de Zeeuw D, Agarwal R, Amdahl M, Audhya P, Coyne D, Garimella T, et al. Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. Lancet 2010; 376(9752): 1543–51.

Kim MJ, Frankel AH, Donaldson M, Darch SJ, Pusey CD, Hill PD, et al. Oral cholecalciferol decreases albuminuria and uri-nary TGF-β1 in patients with type 2 diabetic nephropathy on established renin-angiotensin-aldosterone system inhibition. Kidney Int 2011; 80(8): 851–60.

Molina P, Górriz JL, Molina MD, Peris A, Beltrán S, Kanter J, et al. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Neph-rol Dial Transplant 2014; 29(1): 97–109.

Huang Y, Yu H, Lu J, Guo K, Zhang L, Bao Y, et al. Oral sup-plementation with cholecalciferol 800 IU ameliorates albumi-nuria in Chinese type 2 diabetic patients with nephropathy. PLoS One 2012; 7(11): e50510.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epi-demiology Collaboration). A new equation to estimate glo-merular filtration rate. Ann Intern Med 2009; 150(9): 604–12.

Li X, Liu Y, Zheng Y, Wang P, Zhang Y. The Effect of Vitamin D Supplementation on Glycemic Control in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis. Nutrients 2018 19; 10(3). pii: E375.

Momeni A, Mirhosseini M, Kabiri M, Kheiri S. Effect of vitamin D on proteinuria in type 2 diabetic patients. J Nephropathol 2017; 6(1): 10–4.

Liyanage GC, Lekamwasam S, Weerarathna TP, Liyanage CE. Effects of high-dose parenteral vitamin D therapy on lipid profile and blood pressure in patients with diabetic nephropa-thy: A randomized double-blind clinical trial. Diabetes Metab Syndr 2017; 11 Suppl 2: S767–S770.

Rafiq S, Jeppesen PB. Is Hypovitaminosis D Related to Inci-dence of Type 2 Diabetes and High Fasting Glucose Level in Healthy Subjects: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2018 10; 10(1). pii: E59.

Garbossa SG, Folli F. Vitamin D, sub-inflammation and insulin resistance. A window on a potential role for the interaction between bone and glucose metabolism. Rev Endocr Metab Disord 2017; 18(2): 243–58.

Lee CJ, Iyer G, Liu Y, Kalyani RR, Bamba N, Ligon CB, et al. The effect of vitamin D supplementation on glucose metabo-lism in type 2 diabetes mellitus: A systematic review and meta-analysis of intervention studies. J Diabetes Complications 2017; 31(7): 1115–26.

Berridge MJ. Vitamin D deficiency and diabetes. Biochem J. 2017; 474(8): 1321–32.

Wada J, Makino H. Inflammation and the pathogenesis of dia-betic nephropathy. Clin Sci (Lond) 2013; 124(3): 139–52.

Duran-Salgado MB, Rubio-Guerra AF. Diabetic nephropathy and inflammation. World J Diabetes 2014; 5(3): 393–8.

Asemi Z, Samimi M, Tabassi Z, Shakeri H, Esmaillzadeh A. Vit-amin D supplementation affects serum high-sensitivity C-reactive protein, insulin resistance, and biomarkers of oxida-tive stress in pregnant women. J Nutr 2013; 143(9): 1432–8.

Ramiro-Lozano JM, Calvo-Romero JM. Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency. Ther Adv Endocrinol Metab 2015; 6(6): 245–8.

Objavljeno
2021/04/19
Broj časopisa
Vol. 77 Br. 6 (2020): Vojnosanit pregl
Rubrika
Originalni članak