Renal replasman tedavisi almayan evre 3-5 kronik böbrek hastalığı olan hastalarda vitamin D düzeyinin inflamatuvar parametreler ve proteinüri ile ilişkisi

Öz

Amaç: Kronik böbrek hastalığı (KBH) ve proteinürisi olanlarda artmış oksidatif stres ve inflamasyonun kardiyovasküler morbidite ve mortalite ile ilişkili olduğu gösterilmiştir. Vitamin D’nin (VD) organizmada birçok rolünün olduğu son yıllarda VD reseptörünün çok sayıda dokuda gösterilmesiyle anlaşılmıştır. Bu çalışmada KBH olan bireylerde VD düzeyinin, inflamatuvar parametreler ve proteinüri ile ilişkisini değerlendirmeyi amaçladık. Gereç-Yöntem: Çalışmaya nefroloji polikliniğinde takip edilen ve henüz renal replasman tedavisi almamış, evre 3-5 KBH hastalar arasından dahil etme kriterlerini karşılayan 314 hasta alındı. Katılımcıların verileri retrospektif ve kesitsel olarak incelendi. Demografik özellikleri, kreatinin, tahmini glomerüler filtrasyon hızı (t GFH), serum 25(OH)D3, kalsiyum, albümin, fosfor, parathormon (PTH), spot idrarda protein/kreatinin oranı, nötrofil, lenfosit, platelet, nötrofil/lenfosit oranı (NLO) ve platelet/lenfosit oranı (PLO) kaydedildi. Serum 25(OH)D3 düzeyine göre; VD eksikliği olanlar, (<10 ng/ml), VD yetersizliği olanlar (10-29 ng/ml) ve VD düzeyi normal olanlar (>29 ng/ml) olmak üzere 3 grup oluşturuldu. Gruplar, inflamatuvar parametreler ve proteinüri düzeyi yönünden karşılaştırıldı. Analizler SPSS 23.0 programı ile yapıldı. Bulgular: VD grupları arasında inflamatuvar parametreler (CRP, NLO ve PLO) açısından fark saptanmadı. Spot idrarda protein/kreatinin oranı VD eksikliği olanlarda, hem VD yetersizliği olanlardan (p:0, 007) hem de VD düzeyi normal olanlardan (p: 0,001) daha yüksekti. Ayrıca yapılan korelasyon analizinde VD düzeyi ile proteinüri arasında negative korelasyon saptandı (r: -267, p: <0,01). Nefrotik düzeyin altında proteinürisi olan bireylerde de VD düzeyi ve proteinüri ilişkisinin korunduğu saptandı (p: 0,018). Sonuç: Proteinüri düzeyinin, VD düzeyi ile negatif korelasyon gösterdiği ve VD eksikliği olanlarda daha yüksek değerlere ulaştığı görüldü. Bu noktada renal ve kardiyovasküler açıdan önemli bir faktör olan proteinürinin azaltılması noktasında VD’nin rolü gündeme gelebilir.

Anahtar Kelimeler

• Vitamin D eksikliği
• kronik böbrek hastalığı
• inflamasyon
• proteinüri

The association of vitamin D status with inflammatory parameters and proteinuria in patients with stage 3-5 chronic kidney disease who are not on renal replacement therapy

Abstract

Objective: It has been demonstrated that increased oxidative stress and inflammation are associated with increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) and proteinuria. In recent years, it has been understood that vitamin D (VD) has many roles, with the demonstration of the VD receptor in many tissues. In this study, we aimed to evaluate the association of VD level with inflammatory parameters and proteinuria in individuals with CKD. Method: The study included 314 patients who were followed up in the nephrology outpatient clinic with the diagnosis of CKD, had not received renal replacement therapy yet and met the inclusion criteria. The data of the participants were analyzed retrospectively and cross-sectionally. Demographic characteristics, creatinine, estimated glomerular filtration rate, serum 25(OH)D3, calcium, albumin, phosphorus, parathormone (PTH), spot urine protein/creatinine ratio, neutrophil, lymphocyte, platelet, neutrophil/lymphocyte ratio (NLR) and platelet /lymphocyte ratio (PLR) were recorded. According to serum 25(OH)D3 level; Three groups were formed those with VD deficiency (<10 ng/ml), those with VD insufficiency (10-29 ng/ml), and those with normal VD level (>29 ng/ml). The groups were compared in terms of inflammatory parameters and proteinuria levels. Analyzes were performed by using the SPSS 23.0 program. Results: There was no difference between the VD groups in terms of inflammatory parameters (CRP, NLR, and PLR). The protein/creatinine ratio in spot urine was higher in patients with VD deficiency than both those with VD insufficiency (p:0.007) and those with normal VD levels (p:0.001). In addition, a negative correlation was found between VD level and proteinuria (r: -267, p: <0.01). It was found that the association between VD level and proteinuria was preserved in individuals with proteinuria below the nephrotic level (p: 0.018). Conclusion: It was observed that the proteinuria level was negatively correlated with the VD level and reached higher values in those with VD deficiency. At this point, the role of VD in reducing proteinuria, which is an important factor in renal and cardiovascular terms, may become a current issue.

Keywords

• Vitamin D deficiency
• chronic kidney disease
• inflammation
• proteinuria

Kaynakça

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