Vitamin D3 effect on Albuminuria in Type 2 Diabetes Mellitus patients in Northern Andhra Pradesh, India
Abstract
Introduction: Vitamin D deficiency is a common disorder in diabetic patients and may be a risk factor for the progression of diabetic nephropathy. The present study aimed to assess the effects of a large dose of parenteral. Vitamin D on 24 hours albuminuria in T2DM patients.
Methods: This prospective single-center study included 80 vitamin D deficient [25(OH) D <50 nmol/l] T2DM patients with an adequate glycemic control (HbA1c< 7.0%). Without any changes in anti-hyperglycemic or antihypertensive drugs, these patients were given a single high dose (600000 IU) of parenteral Vitamin D3. Then the changes in Vitamin D levels and 24 hours albuminuria were seen on follow up at 3 months.
Results: Vitamin D3 supplementation improved 24 hours albuminuria. In the present study, Twenty-four-hour urinary albumin excretion decreased from 210.4 ± 101.2 to 204.6 ± 104.5. In males, it changed from 221.8 ± 99.7 to 216.1 ± 100.3 and in females, it changed from 192.3 ± 108.5 to 186.7 ± 113.1. There was a negative association of albuminuria with Vit D levels in the present study.
Conclusion: Vitamin D3 supplementation significantly reduces 24-hour urinary albumin excretion in T2DM patients with Vitamin D3 deficiency.
Downloads
References
Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2005; 28(1):164-76. doi:10.2337/diacare.28.1.164.
Rüster, C, Wolf G. Renin–angiotensin–aldosterone system and progression of renal disease. J Am Soc Nephrol. 2006; 17: 2985–2991.
Li YC, Qiao G, Uskokovic M, et al. Vitamin D: a negative endocrine regulator of the reninangiotensin system and blood pressure. J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):387-92.
Ramon Sonneveld, Silvia Ferrè, Joost G.J. Hoenderop, Henry B Dijkman, Jo H.M. Berden, René J M Bindels, et al. Vitamin D Down- Regulates TRPC6 Expression in Podocyte Injury and Proteinuric Glomerular Disease. The American Journal of Pathology Volume 182, Issue 4, April 2013, Pages 1196–1204.
Huang Y, Yu H, Lu J, Guo K, Zhang L, Bao Y,et al. Oral supplementation with cholecalciferol 800 IU ameliorates albuminuria in Chinese type 2 diabetic patients with nephropathy. PloS One. 2012;7(11):e50510. doi:10.1371/journal.pone.0050510 .
Yan Zhang, Juan Kong, Dilip K Deb, et al. Vitamin D Receptor Attenuates Renal Fibrosis by Suppressing the Renin-Angiotensin System.J Am Soc Nephrol. 2010 Jun; 21(6): 966–973.
Zhang Z, Zhang Y, Ning G, et al. Combination therapy with AT1 blocker and vitamin D analog markedly ameliorates diabetic nephropathy: blockade of compensatory renin increase. Proc Natl Acad Sci U S A. 2008 Oct 14;105(41):15896-90.
Pittas AG, Lau J, Hu FB, et al. The role of vitamin D and calcium in type 2 diabetes: A systematic review and meta-analysis. J Clin Endocrinol Metab 92: 2017-2029.
G Klaus. Renoprotection with vitamin D: specific for diabetic nephropathy. Kidney International, vol. 73, no. 2, pp. 141–143,2008.
V A Diaz, A G Mainous III, P J Carek, et al. The association of vitamin D deficiency and insufficiency with diabetic nephropathy: implications for health disparities. Journal of the American Board of Family Medicine, vol. 22, no. 5, pp. 521–527, 2009.
Collins AJ, Kasiske B, Herzog C, Chavers B, Foley R, Gilbertson D, et al. Excerpts from the United States Renal Data System 2006 Annual Data Report. Am J Kidney Dis 2007;49(1 Suppl 1): A6-7. doi: 10.1053/j. Ajkd.2006.11.019.
Jacob AN, Khuder S, Malhotra N, Sodeman T, Gold JP, Malhotra D, et al. Neural network analysis to predict mortality in end-stage renal disease: application to United States Renal Data System. Nephron Clin Pract. 2010;116(2):c148-58. Doi: 10.1159/000315884.
KDIGO. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl2013;3(1):1-150.
Abbate M, Zoja C, Remuzzi G. How does proteinuria cause progressive renal damage. J Am Soc Nephrol 2006;17:2974-84.
Palmer BF. Proteinuria as a therapeutic target in patients with chronic kidney disease. Am J Nephrol 2007;27:287-93.
Ruggenenti P, Perna A, Mosconi L, et al. Urinary protein excretion rate is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies. Gruppo Italiano di Studi Epidemiologici in Nefrologia» (GISEN). Kidney Int 998;53:1209-16.
Taal MW, Brenner BM. Predicting initiation and progression of chronic kidney disease: Developing renal risk scores. Kidney Int 2006;70:1694-705.
Górriz JL, Molina P, Bover J et al. Characteristics of bone mineral metabolism in patients with stage 3–5 chronic kidney disease not on dialysis: results of the OSERCE study. Nefrologia 2013; 33:46–60.
Mehrotra R, Hermah D, Budoff M et al. Hypovitaminosis D in chronic kidney disease. Clin J Am Soc Nephrol 2008; 1144–1151.
Levin A, Bakris GL, Molitch M et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorous in patients with chronic kidney disease. Kidney Int 2007; 71: 31–38.
LaClair R, Hellman RN, Karp SL et al. Prevalence of calcidiol deficiency in CKD: a cross- sectional study across latitudes in the United States. Am J Kidney Dis 2005; 45: 1026–1033.
Gonzalez ES, Sachdeva A, Oliver DA et al. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004; 24: 503–510.
Looker AC, Dawson-Hughes B, Calvo MS et al. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 2002; 30: 771–777.
Al-Badr W, Martin KJ. Vitamin D and kidney disease. Clin J Am Soc Nephrol 2008; 3: 1555– 1560.
Alvarez JA, Law J, Coakley KE et al. High- dose cholecalciferol reduces parathyroid hormone in patients with early chronic kidney disease: a pilot, randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2012; 96: 672–679.
Marckmann P, Agerskow H, Thineshkumar S et al. Randomized controlled trial of cholecalciferol supplementation in chronickidney disease patients with hypovitaminosis D. Nephrol Dial Transplant 2012; 27: 3523–3531.
Moe SM, Saifullah A, LaClair RE et al. A randomized trial of cholecalciferol versus doxercalciferol for lowering parathyroid hormone in chronic kidney disease. Clin J Am Soc Nephrol 2010; 5: 299–306.
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. doi: 10.1038/sj.ki.5002572.
Schwarz U, Amann K, Orth SR, Simonaviciene A, Wessels S, Ritz E. Effect of 1,25 (OH)2 vitamin D3 on glomerulosclerosis in subtotally nephrectomized rats. Kidney Int. 1998;53(6):1696- 705. doi: 10.1046/j.1523- 1755.1998.00951.
Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: Endocr Rev. 2001.
Ahmadi N, Mortazavi M, Iraj B, et al. Whether vitamin D3 is effective in reducing proteinuria in type 2 diabetic patients. J Res Med Sci. 2013;18(5):374-7.
Kim MJ, Frankel AH, Donaldson M, Darch SJ, Pusey CD, Hill PD, et al. Oral cholecalciferol decreases albuminuria and urinary TGF-beta1 in patients with type 2 diabetic nephropathy on established renin-angiotensin-aldosterone system inhibition. Kidney Int. 2011;80(8):851-60.
Ali Momeni, Mahmood Mirhosseini, Mohsen Kabiri, et al. Effect of vitamin D on proteinuria in type 2 diabetic patients. J Nephropathol. 2017 Jan; 6(1): 10–14.
Bonakdaran S, Hami M, Hatefi A. The effects of calcitriol on albuminuria in patients with type-2 diabetes mellitus. Saudi J Kidney Dis Transpl. 2012;23(6):1215- 20. doi: 10.4103/1319- 2442.103562.
De Zeeuw D, Agarwal R, Amdahl M, Audhya P 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 Nov6 6;376(9752):1543-51.
Molina P, Górriz JL, Molina MD, et al. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant (2014) 29 (1): 97- 109.
Agarwal R, Acharya M, Tian J, Hippensteel RL, Melnick JZ, Qiu P, et al. Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney Int 2005;68:2823-8.
Fishbane S, Chittineni H, Packman M, Dutka P, Ali N, Durie N. Oral paricalcitol in the treatment of patients with CKD and proteinuria: a randomized trial. Am J Kidney Dis 2009;54:647- 52.
Liu LJ, Lv JC, Shi SF, Chen YQ, Zhang H, Wang HY. Oral calcitriol for reduction of proteinuria in patients with IgA nephropathy: a randomized controlled trial. Am J Kidney Dis 2012;59:67-74.
R Scragg, M Sowers, C Bell. Serum 25- hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care, vol. 27, no. 12,pp. 2813– 2818, 2004.
Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
