Onur YAZDAN BALÇIK, Feyza BORA, Sadi KÖKSOY, Fettah Fevzi ERSOY

9124

EVRE 3-5 KRONİK BÖBREK HASTALARINDA HEMATOPOETİK HÜCRELERDEKİ VİTAMİN D RESEPTÖR DÜZEYİ İLE İNFLAMASYON BELİRTEÇLERİNİN DEĞERLENDİRİLMESİ

ÖZ: Amaç: Bu çalışmada, evre 3-5 Kronik böbrek hastalarında (KBH) vitamin D replasmanının CD3+, CD4+, CD8+ ve CD14+ hematopoietik hücre alt gruplarındaki vitamin D reseptör (VDR) yüzdesi ile inflamatuar belirteçlerle ilişkisini değerlendirmeyi amaçladık. Yöntem: Bu prospektif çalışmada evre 3-5 KBH’sı olan; tahmini glomerüler filtrasyon hızı (tGFH) ≤60ml/dk/1,73m2 olan 81 hasta katıldı. Serum kreatinin, tGFH, intakt parathormon (iPTH), 25 OH vitamin D düzeyleri, CRP, nötrofil, lenfosit değerleri ve CD3+, CD4+, CD8+, CD14+ hematopoietik hücrelerde VDR yüzdeleri hesaplandı. Hastalar, 25 OH VD3 düzeylerine göre Vitamin D eksikliği tanısıyla (<20 ve ≥20 ng/dl) iki gruba, KBH evrelerine göre (evre 3-5) üç gruba, D vitamini kullanımı durumuna göre (kullanmıyor, kalsitriol veya 25 OH vitamin D) üç gruba ayrıldı. Bulgular: Vitamin D eksikliği tanısıyla iki gruba ayrılan hastalarda aktif D vitamini kullanımı, kreatinin, tGFH ve iPTH düzeyleri arasında istatistiksel anlamda fark tespit edildi (p:0,04, p:0,008, p:0,02 ve p:0,002). CRP ve nötrofil /lenfosit oranı arasında istatistiksel fark tespit edilmedi (p:0,95, p:0,63). Hastaları KBH evrelerine göre gruplandırdığımızda iPTH düzeylerinde istatistiksel fark tespit edildi (p:0,001). Hastaları D vitamini kullanımı durumuna göre üç gruba ayırdığımızda kreatinin, tGFH, iPTH ve 25 OH vitamin D3 düzeyleri arasında istatistiksel fark tespit edildi (p:0,00, p:0,00, p: 0,02 ve p:0,006). CD3 +, CD4 +, CD8 +, CD14 + hematopoietik hücrelerde VDR yüzdeleri arasında bir fark tespit edilmedi (p:0,17, p:0,15, p:0,14, p:0,31). Lenfosit düzeyleriyle tGFH değerleri arasında istatistiksel bir korelasyon vardı (r:0,28, p:0,011). Lenfosit düzeyleriyle CD8+ hücrelerin VDR yüzdesi değerleri arasında istatistiksel bir korelasyon vardı (r:0,224, p:0,046). Sonuç: Replasman tedavileri ile VDR yüzdelerinin tüm evrelerde benzer oranlarda tutulabileceği, inflamasyonda azalma sağlanmış olabileceğinden kaynaklı olabilir. ANAHTAR KELİMELER: İnflamasyon, Kronik Böbrek Hastalığı, Vitamin D, Vitamin D Reseptör Düzeyi
Anahtar Kelimeler:

İnflamasyon, Kronik Böbrek Hastalığı, Vitamin D, Vitamin D Reseptör Düzeyi

EVALUATION OF VITAMIN D RECEPTOR LEVEL IN HEMATOPOETIC CELLS AND INFLAMMATORY MARKERS IN STAGE 3-5 CHRONIC RENAL PATIENTS

ABSTRACT: In this study, we aimed to compare the relationship of vitamin D replacement with the percentage of vitaminD receptor (VDR) in CD3+, CD4+, CD8+ and CD14+ hematopoietic cells and inflammatory markers in stage 3-5 CKD patients. METHOD: In this prospective study, 81 stage 3-5 CKD patients with estimated glomerular filtration rate (eGFR)≤60ml/min/1.73m2 were included. Serum creatinine, eGFR, intact parathormone (iPTH), 25 OH Vitamin D3 levels, CRP, neutrophil, lymphocyte values and VDR percentages in CD3+,CD4+,CD8+,CD14+ hematopoietic cells were calculated. Patients were divided into groups with a diagnosis of Vitamin D deficiency (<20and≥20 ng/dl) according to 25 OH Vitamin D3 levels, according to CKD stages (stages 3,4 and 5) and according to their vitamin D use status (not using,using calcitriol or 25 OH vitamin D). RESULTS: A statistically significant difference was found between active vitaminD use, creatinine, eGFR and iPTH levels in patients who were divided groups for vitamin D deficiency (p:0.04, p:0.008, p:0.02, p:0.002). There was no statistical difference between CRP and neutrophil/lymphocyte ratio (p:0.95, p:0.63). When we grouped the patients according to CKD stages, a statistical difference was found in iPTH levels (p:0.001). When we divided the patients according to their use of 25 OH vitamin D, a statistical difference was found between creatinine, eGFR, iPTH and 25 OH vitamin D3 levels (p:0.00, p:0.00, p: 0.02 and p:0.006). There was no difference between the percentages of VDR in CD3+, CD4+, CD8+, CD14+ hematopoietic cells (p:0.17, p:0.15, p:0.14, p:0.31). RESULTS: It may be due to the fact that VDR percentages can be kept at similar rates in all stages with Vitamin D replacement therapies and a decrease in inflammation may be achieved. KEYWORDS: Chronic Kidney Disease, Inflamation, Vitamin D, Vitamin D Receptor Level
Keywords:

Chronic Kidney Disease, Inflamation, Vitamin D, Vitamin D Receptor Level,

PDF

___

  • 1. Dai L, Golembiewska E, Lindholm B, Stenvinkel P. End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes. Contrib Nephrol 2017; 191:32-43.
  • 2. Gupta J, Mitra N, Kanetsky PA, et al. CRIC Study Investigators Association between albuminuria, kidney function, and inflammatory biomarker profile in CKD in CRIC. Clin J Am Soc Nephrol 2012; 7: 1938–1946.
  • 3. Cobo G, Lindholm B, Stenvinkel P. Chronic inflammation in end-stage renal disease and dialysis Nephrol Dial Transplant 2018 Oct 1;33(suppl 3): iii35-iii40.
  • 4. Jankowska M, Cobo G, Lindholm B et al. Inflammation and protein-energy wasting in the uremic milieu. Contrib Nephrol 2017; 191: 58–71.
  • 5.Gonzalez EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004; 24:503-10.
  • 6.Figuiredo-Dias V, Cuppari L, Garcia-Lopes MG, de Carvalho AB, Draibe SA, Kamimura MA. Risk factors for hypovitaminosis D in nondialyzed chronic kidney disease patients. J Ren Nutr 2012;22: 4-11.
  • 7.Dusso AS, Brown AJ, Slatopolsky E. Vitamin D. Am. J. Physiol. Ren. Physiol 2005; 289: F8–F28.
  • 8.Fraser DR, Kodicek, E. Unique biosynthesis by kidney of a biological active vitamin D metabolite. Nature 1970; 228: 764–66.
  • 9.Andress DL. Vitamin D in chronic kidney disease: a systemic role for selective vitamin D receptor activation. Kidney Int 2006; 69:33-43.
  • 10.Adams JS, Rafison B, Witzel S, Reyes RE, Shieh A, Chun R, Zavala K, Hewison M, Liu PT. Regulation of the extrarenal CYP27B1-hydroxylase. J Steroid Biochem Mol Biol 2014; 144:22-7.
  • 11.Cunningham J, Zehnder D. New vitamin D analogs and changing therapeutic paradigms. Kidney Int 2011; 79:702-7.
  • 12.Christakos S, DeLuca HF. Minireview: vitamin D: is there a role in extraskeletal health? Endocrinology 2011; 152:2930-6.
  • 13.Zhang Y, Leung DY, Richers BN, Liu Y, Remigio LK, Riches DW, Liu Y, Remigio LK, Riches DW, Goleva E. Vitamin D inhibits monocyte/macrophage proinflammatory cytokine production by targeting MAPK phosphatase-1. J Immunol 2012;188:2127-35.
  • 14.Valdivielso JM, Fernandez E. Vitamin D receptor polymorphisms and diseases. .Clin Chim Acta 2006; 371:1-12.
  • 15.Baeke F, Korf, H, Overbergh L, van Etten E, Verstuyf A, Gysemans C, Mathieu, C. Human T. lymphocytes are direct targets of 1,25-dihydroxyvitamin D3 in the immune system. J. Steroid Biochem. Mol. Biol 2010; 121: 221–7.
  • 16.Mahon BD, Wittke A, Weaver V, Cantorna, MT. The targets of vitamin D depend on the differentiation and activation status of CD4 positive T cells. J. Cell. Biochem 2003; 89: 922–32.
  • 17.Takiishi T,Van Belle T, Gysemans C, Mathieu C. Effects of vitamin D on antigenspecific and non-antigen-specific immune modulation: Relevance for type 1 diabetes. Pediatr. Diabetes 2013; 14: 81–9.
  • 18.Jeffery LE, Burke F, Mura M, Zheng Y, Qureshi OS, Hewison, M, Ker LS, Lammas, DA, Raza K, Sansom, DM. 1,25-Dihydroxyvitamin D3 and IL-2 combine to inhibit T cell production of inflammatory cytokines and promote development of regulatory T cells expressing CTLA-4 and FoxP3. J. Immunol 2009; 183: 5458–67.
  • 19.Cantorna, MT, Snyder L, LinYD, Yang, L. Vitamin D and 1,25(OH)2D regulation of T cells. Nutrients 2015; 7: 3011–21.
  • 20. Baeke F, Gysemans C, Korf H, Mathieu C. Vitamin D insufficiency: Implications for the immune system. Pediatr. Nephrol 2010; 25: 1597–606.
  • 21.Li YC, 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.
  • 22.Drechsler C, Verduijn M, Pilz S, Dekker FW, Krediet RT, Ritz E, Wanner C, Boeschoten EW, Brandenburg V; NECOSAD Study Group. Vitamin D status and clinical outcomesin incident dialysis patients: results from the NECOSAD study. Nephrol Dial Transplant 2011; 26:1024-32.
  • 23.Honda H, Qureshi AR, Heimbürger O, Barany P, Wang K, Pecoits-Filho R, Stenvinkel P, Lindholm B. Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis 2006; 47:139-48.
  • 24.M Wolf , A Shah, O Gutierrez, E Ankers, M Monroy, H Tamez, D Steele, Y Chang, C A Camargo Jr, M Tonelli, R Thadhani Vitamin D levels and early mortality among incident hemodialysis patients Kidney Int 2007;72:1004-13.
  • 25.Zoccali C, Vanholder R, Massy ZA, et al. Wiecek A and London G; on behalf of the European Renal and Cardiovascular Medicine (EURECA-m) Working Group of the European Renal Association – European Dialysis Transplantation Association (ERA-EDTA). The systemic nature of CKD. Nature 2017;13: 344-58.
  • 26.Gupta J , Mitra N, Kanetsky P, et al. CRIC Study Investigators Association between albuminuria, kidney function, and inflammatory biomarker profile in CKD in CRIC. Clin. J Am Soc Nephrol 2012; 7: 1938–46.
  • 27.Cohen G, Haag-Weber M, Horl WH. Immune dysfunction in uremia. Kidney Int Suppl 1997; 62:79–82.
  • 28.Girndt M, Sester M, Sester U, Kaul H, Kohler H. Molecular aspects of T- and B-cell function in uremia.Kidney Int Suppl 2001;78:206–11.
  • 29.Vaziri ND, Pahl MV, Crum A, Norris K. Effect of uremia on structure and function of immune system. J Ren Nutr 2012; 22:149–56.
  • 30.Williams S, Malatesta K, Norris K. Vitamin D and chronic kidney disease. Ethn Dis 2009; 19:8-11.
  • 31.Melamed ML, Thadhani RI. Vitamin D therapy in chronic kidney disease and end stage renal disease. Clin J Am Soc Nephrol 2012; 7:358-65.
  • 32. Franca Gois PH, Wolley M, Ranganathan D, Seguro AC. Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies. Int J Environ Res Public Health. 2018; 15:1773.
  • 33. Martens PJ, Gysemans C, Verstuyf A, Mathieu C. Vitamin D’s Effect on Immune Function Nutrients 2020; 12:1248.
  • 34.Colotta, F., Jansson, B., Bonelli, F. Modulation of inflammatory and immune responses by vitamin D. J Autoimmun 2017; 85: 78–97.
  • 35.Xu, H, Soruri, A, Gieseler RK, Peters, J.H. 1,25-Dihydroxyvitamin D3 exerts opposing effects to IL-4 on MHC class-II antigen expression, accessory activity, and phagocytosis of human monocytes. Scand J Immunol 1993; 38: 535–40.
  • 36.Baeke F,Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: Modulator of the immune system. Curr. Opin. Pharmacol 2010; 10: 482–96.
  • 37.Baeke F, Etten EV, Overbergh, L, Mathieu C. Vitamin D3 and the immune system:Maintaining the balance in health and disease. Nutr Res Rev 2007; 20: 106–18.
  • 38.van Halteren, AG, Tysma OM, van Etten E, Mathieu C, Roep BO. 1alpha,25dihydroxyvitamin D3 or analogue treated dendritic cells modulate human autoreactive T cells via the selective induction of apoptosis. J Autoimmun 2004; 23: 233–9.
  • 39. Carvalho JTG, Schneider M, Cuppari L, Grabulosa CC, T Aoike D, Q Redublo BM, C Batista M, Cendoroglo M, Maria Moyses R, Dalboni MA. Cholecalciferol decreases inflammation and improves Vitamin D regulatory enzymes in lymphocytes in the uremic environment: a randomized controlled pilot trial. PLoS One 2017;30: 12(6): e0179540.
  • 40.Meireles MS , Kamimura MA, Dalboni MA , Carvalho JTG , Aoike DT, Cuppari L. Effect of cholecalciferol on vitamin D-regulatory proteins in monocytes and on inflammatory markers in dialysis patients: A randomized controlled trial Clin Nutr 2016;35:1251-58.
  • 41.Stubbs JR, Idiculla A, Slusser J, Menard R, Quarles LD. Cholecalciferol supplementation Alters Calcitriol-Responsive monocyte proteins and decreases inflammatory cytokines in ESRD. J Am Soc Nephrol 2010; 21:353-61.
  • 42.Sözel H, Köksoy S, Ozdem S, Yılmaz F, Bora F, Ersoy FF. Lymphocyte and monocyte vitamin D receptor expression during paricalcitol or calcitri ol treatments in patients with stage 5 chronic kidney disease. Int Urol Nephrol. 2020; 52:1563-70.
  • 43.KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease—Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl 2017; 7: 1–59.
  • 44.Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, Andress DL. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007; 71:31-8.
  • 45.Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect 2006; 134: 1129- 40.
  • 46.Camargo CA JR, Ganmaa D, Frazier AL, Kirchberg FF, Stuart JJ, Kleinman K, Sumberzul N, Rich-Edwards JW. Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Pediatrics 2012; 130:561-7.
  • 47.Selvaraj P, Harishankar M, Afsal K. Vitamin D: Immuno- modulation and tuberculosis treatment. Can J Physiol Pharmacol 2015; 93: 377-84.
  • 48. Ravani P, Malberti F, Tripepi G, Pecchini, P, Cutrupi, S, Pizzini, P, Mallamaci F Zoccali C. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int. 2009; 75: 88–95.
  • 49.Mucsi I, Almási C, Deák G, Marton A, Ambrus, C, Berta K, Lakatos P, Szabó A, Horváth, C. Serum 25(OH)-vitamin D levels and bone metabolism in patients on maintenance hemodialysis. Clin Nephrol 2005; 64:288–94.
  • 50.Milinkovi ́c, NL, Majki ́c-Singh NT, Mirkovi ́c DD, Beleti ́c AD, Pejanovi ́c, SD, Vujani ́c ST. Relation between 25(OH)-vitamin D deficiency and markers of bone formation and resorption in haemodialysis patients. Clin Lab 2009; 55: 333–9.
  • 51.Holick, M. Vitamin D for Health and In Chronic Kidney Disease. Semin. Dial 2005; 8: 266–75.
Akdeniz Tıp Dergisi-Cover
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 2015
  • Yayıncı: Akdeniz Üniversitesi Tıp Fakültesi
Arşiv
Sayıdaki Diğer Makaleler

Prediyaliz Kronik Böbrek Hastalığında bitkisel ilaç kullanımının değerlendirilmesi

Feyza BORA, Emine ASAR, Esin AVŞAR, Hasan SÖZEL, Fatih YILMAZ

EVRE 3-5 KRONİK BÖBREK HASTALARINDA HEMATOPOETİK HÜCRELERDEKİ VİTAMİN D RESEPTÖR DÜZEYİ İLE İNFLAMASYON BELİRTEÇLERİNİN DEĞERLENDİRİLMESİ

Onur YAZDAN BALÇIK, Feyza BORA, Sadi KÖKSOY, Fettah Fevzi ERSOY

ACİL SERVİSE BAŞVURAN HASTALARDA PULMONER BT ANJİOGRAFİ TETKİKİNİN TANI VERİMLİLİĞİNİN DEĞERLENDİRİLMESİ

Şenay Bengin ERTEM, Nilüfer AYLANÇ, Murat DAŞ, Okan BARDAKÇI

Akdeniz Üniversitesi Diş Hekimliği Fakültesi’ ne başvuran hastalarda konik ışınlı bilgisayarlı tomografi istem nedenlerinin incelenmesi

Hümeyra TERCANLI ALKIŞ