Böbrek nakli hastalarında vitamin D düzeyi ve 24 saatlik ambulatuar kan basıncı ilişkisi

Amaç: Böbrek transplantasyonu böbrek yetmezliğinin en önde tedavisidir. Renal transplant hastalarında D vitamini eksikliği yaygın görülmektedir. Vitamin D Renin-anjiyotensin-aldosteron sistemi inhibisyonu ile hipertansiyon ve kardiyovasküler hastalıklardan korumaktadır. Bu çalışmadaki amaç, vitamin D düzeyleri ile 24 saatlik ambulatuar kan basıncı ve greft fonksiyonunu etkileyebilecek parametreler (vücut kitle indeksi, açlık plazma glikozu, lipit profili) arasındaki ilişkiyi belirlemektir.Yöntem ve Gereç: Renal transplant hastalarında klinik parametreler, D vitamini düzeyleri ve kan basıncı arasındaki ilişki karşılaştırıldı. Tüm hastaların kan basıncı seviyeleri 24 saatlik ambulatuar kan basıncı takibi ile değerlendirildi.Bulgular: Çalışmaya toplam 115 renal transplant hastası alındı. Ortalama D vitamini düzeyi 16,28 ± 5,2ng/ml olup hastaların % 10,4'ünde ciddi vitamin D yetmezliği (<10ng / ml), ve % 70,4'ünde vitamin D eksikliği (10-20ng/ml) saptandı. D vitamini eksikliği (10-20ng/ml) kadınlarda erkeklerden daha sık olduğu bulundu. Çalışmada hastalar iki gruba ayrıldı, birinci gurup vitamin D düzeyi 20 ng/ml'den az olanlar, ikinci gurup vitamin D düzeyi 20 ng/ml'ye eşit ya da daha yüksek olanlar. İki grup arasında yaş, vücut kitle indeksi ve donör özelliklerinde istatistiksel olarak anlamlı fark yoktu. Sistolik, diyastolik ve ortalama 24 saatlik ambulatuar kan basıncı her iki grupta benzerdi. Sonuç: D vitamini eksikliği renal transplant hastalarında yaygın olduğu saptandı. Renal transplant hastalarında vitamin D düzeyinin kan basıncı ile ilişkili olmadığı bulundu.

Anahtar Kelimeler:

Hipertansiyon, vitamin D, böbrek nakli, 24 saatlik ambulatuvar kan basıncı, greft fonksiyonu

The relationship between vitamin D levels and 24-hour ambulatory blood pressure in renal transplantation patients

Aim: Renal transplantation is the most prominent treatment of renal insufficiency. Vitamin D deficiency found to be common in renal transplant patients. Through renin-angiotensin-aldosterone system inhibition, it protects from hypertension and cardiovascular diseases. In this study, we investigated the relation between vitamin D levels and 24-hour ambulatory blood pressure monitoring and parameters (body mass index, fasting plasma glucose, lipid profile) that may affect graft function. Material and Method: Association of clinical parameters with vitamin D levels and blood pressure were prospectively compared in renal transplant patients. All patients blood pressure levels were evaluated by 24-hour ambulatory blood pressure monitoring.Results: A total of 115 renal transplant recipients were enrolled in the study. Mean level of vitamin D was 16.28±5.2ng/ml, 10.4 % of the patients had severe vitamin D insufficiency (<10ng/ml), 70.4 % with a level between 10-20ng/ml. The vitamin D deficiency (10-20ng/ml) was seen more frequently in women than man. Patients has been divided into two groups, the first with levels of less than 20 ng/ml, the second one with levels of equal or higher than 20 ng/ml. There were no statistically significant difference in age, body mass index and donor features between two groups. Systolic, diastolic, and mean artery 24-hour ambulatory blood pressures in two groups were similar. Conclusion: Vitamin D deficiency was found to be common in renal transplant patients. Vitamin D status was not found to be associated with blood pressure in renal transplant patient.

Keywords:

Hypertension, vitamin D levels, renal transplantation, 24-hour ambulatory blood pressure, graft function,

PDF

___

1. Kasiske BL, Zeier MG, Craig JC, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009; 9 Suppl: 1-155.
2. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.2.1 Differential diagnosis of chronic graft dysfunction. Nephrol Dial Transplant 2002;17 Suppl: 4-8.
3. Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006; 116: 2062-72.
4. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 2004; 79: 362-71.
5. Querings K, Girndt M, Geisel J, Georg T, Tilgen W, Reichrath J. 25-hydroxyvitamin D deficiency in renal transplant recipients. J Clin Endocrinol Metab 2006; 91: 526-9.
6. Kasiske BL, Anjum S, Shah R et al. Hypertension after kidney transplantation. Am J Kidney Dis 2004; 43: 1071-81.
7. Ojo AO. Cardiovascular complications after renal transplantation and their prevention. Transplantation 2006; 82: 603-11.
8. Paoletti E, Gherzi M, Amidone M, Massarino F, Cannella G. Association of arterial hypertension with renal target organ damage in kidney transplant recipients: the predictive role of ambulatory blood pressure monitoring. Transplantation 2009; 87: 1864-9.
9. Midtvedt K, Hartmann A. Hypertension after kidney transplantation: are treatment guidelines emerging? Nephrol Dial Transplant 2002; 17: 1166-9.
10. Yuan W, Pan W, Kong J, et al. 1,25 dihydroxyvitamin D3 suppresses renin gene transcription by blocking the activity of the cyclic AMP response element in the renin gene promoter. J Biol Chem 2007; 282: 29821-30.
11. Li C, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25‑dihydroxyvitamin D(3) is a negative endocrine regulator of the renin– angiotensin system. J Clin Invest 2002; 110: 229-38. 12. Resnick LM, Muller FB, Laragh JH. Calcium regulating hormones in essential hypertension. relation to plasma renin activity and sodium metabolism. Ann Intern Med 1986; 105: 649–54.
13. Courbebaisse M, Souberbielle J, Thervet E. Potential nonclassical effects of vitamin D in transplant recipients, Transplantation 2010; 89: 131–7.
14. Stavroulopoulos A, Cassidy MJD, Porter CJ, Hosking DJ, Roe SD. Vitamin status in renal transplant recipients. Am J Transplant 2007; 7: 2546-52.
15. Boudville NC, Hodsman AB. Renal function and 25-hydroxyvitamin D concentrations predict parathyroid hormonelevels in renal transplant patients. Nephrol Dial Transplant 2006; 21: 2621-4.
16. Argiles A. Blood pressure is correlated with vitamin D3 serum levels in dialysis patients. Blood Purif 2002; 20: 370–5.