Role of Vitamin D Status in Diabetic Patients with Renal Disease
Abstract
:1. Overview on Vitamin D
1.1. Vitamin D Metabolism
1.2. Biomarkers of Vitamin D Status
1.3. Vitamin D Serum Level and Supplementation
2. Role of Vitamin D in CKD Patients
3. Vitamin D and Diabetes in Kidney Diseases
3.1. Vitamin D Status in Diabetic Patients with Different Stages of Renal Disease
3.2. Role of Vitamin D Supplementation in Patients with Diabetes and CKD
3.3. Role of Vitamin D in Modulation of RAAS and Microalbuminuria in DN Patients
3.4. Role of Vitamin D in Endothelium and Podocyte Preservation in DN
3.5. Role of Vitamin D in the Prevention of Glomerulosclerosis and Inflammatory Processes in DN
4. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
References
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Vitamin D Levels Associated to Deficiency | Vitamin D Levels Associated to Insufficiency | Adequate Vitamin D Levels | |
---|---|---|---|
Institute of Medicine recommendations | <30 nmol/L (<12 ng/mL) a | 30 ≤ 50 nmol/L (12 ≤ 20 ng/mL) | ≥50 nmol/L (≥20 ng/mL) |
USA Endocrine Society recommendations | <50 nmol/L (<20 ng/mL) | 50–75 nmol/L (20–30 ng/mL) | 75–250 nmol/L (30–100 ng/mL) |
Recommended Vitamin D Dietary Intake | Obese Patients or Patients on Anticonvulsant Medications, Glucocorticoids, Antifungals and Medications for AIDS | Vitamin D Supplementation to Rise the Blood Level of 25(OH)D above 30 ng/mL | |
---|---|---|---|
19–50 yr | At least 600 IU/d | Double or triple dose | At least 1500–2000 IU/d of vit D |
50–70 yr | At least 600 IU/d | Double or triple dose | At least 1500–2000 IU/d of vit D |
70+ yr | At least 800 IU/d | Double or triple dose | At least 1500–2000 IU/d of vit D |
Serum 25 (OH) Vit D Baseline Levels in Different Stages of CKD | |||||
---|---|---|---|---|---|
Study, [Reference], (Year) | Populations Characteristics: Adults with CKD (either Secondary to Type 1 or 2 Diabetes Mellitus) | eGFR <15 mL/min/1.73 m2 (Stage 5) Patients Number (n) | CKD eGFR 15-60 mL/min/1.73 m2 (Stage 3–4) Patients Number (n) | eGFR 60-90 mL/min/1.73 m2 (Stage 2) Patients Number (n) | eGFR <90 mL/min/1.73 m2 (stage 1) Patients Number (n) |
Navaneethan Sankar D [61] (2011) | 2403 (n) DM with stage 3–4 CKD | - | 1626 (n) (67.67%): 15–29 ng/mL | - | - |
age 71.5 ± 11.7 yrs | 777 (n) (32,33%): <15 ng/mL | ||||
33% men, 67% women | |||||
Wahl [62] (2012) | 1820 (n) DM with eGFR 40.7 ± 12.8 mL/min/1.73 m2 | - | 1820 (n) | - | - |
age 59.5 ± 9.8 years | 23.9 ± 13.3 ng/mL | ||||
Peng [63] (2015) | 144 (n) T2DM and eGFR 45.2 (40.3-53.2) mL/min/1.73 m2 | - | 144 (n): 8.5 (6.8-11.3) ng/mL | - | - |
age 65 (IQR 52–75) years, | |||||
65.3% men, 34,7% women | |||||
median diabetes duration 14.5 (IQR 9.5–19.0) years | |||||
Sipahi [64] (2016) | 1463 (n) T2DM and CKD | - | 6 (n) (0.8%) (stage 4) <20 ng/mL | 239 (n) (31.9%): <20 ng/mL | 446 (n) (59.5%): <20 ng/mL |
age 14–88 years | 1 (n) (0.3%) (stage 4): ≥20 and <30 ng/mL | ||||
37% men 63% women | 59 (n) (7.9%) (stage 3) <20 ng/mL | 112 (n) (31.9%): ≥20 and <30 ng/mL | 212 (n) (60.4%): ≥20 and <30 ng/mL | ||
serum level of Vitamin D <20 ng/mL reported in 770 (52.0%) | 25 (n) (7.1%): ≥20 and <30 ng/mL (stage 3) | ||||
serum level ≥20 and <30 ng/mL in 357 (24.0%) patients. | 23 (n) (7.1%) (stage 3): ≥ 30 ng/mL | 106 (n) (32.9%): ≥30 ng/mL | 193 (n) (59.9%): ≥ 30 ng/mL | ||
Xiao [70] (2016) | 240 (n) with T2DM, persistent microalbuminuria (AER 30–300 mg/24 h) or macroalbuminuria (AER >300 mg/24 h) | 60 (n): 7.74 ± 2.90 ng/mL | 60 (n) (stage 4): 8.44 ± 2.53 ng/mL | 60 (n): 12.23 ± 4.07 ng/mL | - |
60 (n) (stage 3): 10.31 ± 3.36 ng/mL | |||||
Ray [71] (2017) | 72 (n) with “DM” | 30 (n): 10.95 (IQR 9.3, 16.4) ng/mL | 42 (n) (stage 4):19.15 (IQR 13.6, 23.4 ng/mL) | - | - |
age 54.2 ± 11.7 years | |||||
44 men, 28 women; | |||||
24.2% of CKD subjects were vitamin D deficient (<10 ng/mL) | |||||
41.4% having vitamin D insufficiency (10–20 ng/mL). |
Population (n) | Intervention (6 Months) | Main Outcomes | |
---|---|---|---|
De Zeeuw [98] (2010) | 281 (n) | 1 μg/d pct or 2 μg/d pct (oral) | UA reduction in 1 μg pct group from 613 to 554 mg/24 h [(95% CI −10% (−25 to 6); change −10% (−25 to 6)]; |
age > 20 yrs | between-group difference –2% (95% CI −23 to 25; p = 0.86) with placebo group | ||
T2DM, albuminuria, | UA reduction in 2 μg pct group from 717 to 463 mg/24 h [(95% CI −34% (−45 to −21)]; | ||
receiving RAAS inhibitors | between-group difference of –28% (95% CI –43 to –8; p = 0.009) with placebo group. | ||
eGFR: 15–90 mL/min/1.73 m2 | Change in UACR –14% (from 63 to 54 mg/mmol; 95% CI−24 to −1) in 1 μg pct group; CI 95% −20% (from 61 to 49 mg/mmol; −30 to −8) in the 2 μg pct group; 16% (from 62 to 51 mg/mmol;95% CI −24 to −9) in the combined pct groups | ||
Tiryaki et al. [99] (2016) | 98 (n) | 0.25 mg calcitriol/d (oral) | UACR from 186.58 ± 22.22 to 142.72 ± 12.38 mg/g (p = 0.014) |
age >18 yrs | |||
T2DM, DN, albuminuria | |||
receiving RAAS inhibitors | UAGT/UCre from 12.96 ± 2.76 to 8.64 ± 2.24 mg/g (p = 0.012) | ||
eGFR > 60 mL/min/1.73 m2 | |||
Liyanage [100] (2018) | 42 (n) | 50,000 IU (0.25 mL)/month cholecalciferol (IM) | UA from 169.4 (35.8) to 117.6 (45.2) mg/g [95% CI; -51.8 (−66.1–−37.5)]. |
age >18 yrs | UACR reduction of 51.8 mg/g (95% CI; −66.1–−37.5) | ||
albuminuria, DN | PR from 14.64 (5.62) to 8.83 (4.81) pg/mL, [95% CI; -5.7 (−6.7–−4.6)]. | ||
eGFR > 30 mL/min/1.73 m2 |
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Gembillo, G.; Cernaro, V.; Salvo, A.; Siligato, R.; Laudani, A.; Buemi, M.; Santoro, D. Role of Vitamin D Status in Diabetic Patients with Renal Disease. Medicina 2019, 55, 273. https://doi.org/10.3390/medicina55060273
Gembillo G, Cernaro V, Salvo A, Siligato R, Laudani A, Buemi M, Santoro D. Role of Vitamin D Status in Diabetic Patients with Renal Disease. Medicina. 2019; 55(6):273. https://doi.org/10.3390/medicina55060273
Chicago/Turabian StyleGembillo, Guido, Valeria Cernaro, Antonino Salvo, Rossella Siligato, Alfredo Laudani, Michele Buemi, and Domenico Santoro. 2019. "Role of Vitamin D Status in Diabetic Patients with Renal Disease" Medicina 55, no. 6: 273. https://doi.org/10.3390/medicina55060273