Interrelation of Vitamin D, Parathyroid Hormone, Calcium and Phosphorus in Stage 3 To Stage 5 Chronic Kidney Disease
Life Sciences-Biochemistry
DOI:
https://doi.org/10.22376/ijpbs/lpr.2022.12.5.L137-144Keywords:
Chronic kidney Disease, Calcium, Phosphorus, Vitamin D, Parathyroid hormoneAbstract
The Kidneys maintains filtration, endocrine function and excretory function. In CKD, the said functions get impaired, that leads to changes in biochemical parameters such as increased concentration of urea and creatinine. Chronic kidney disease also causes hypocalcemia, hyperkalemia, hyperphosphatemia and secondary hyperparathyroidism. The aim of the present study was to assess the interrelationship of vitamin D, Parathyroid hormone, Calcium and phosphorus in Stage 3 to Stage 5 chronic kidney disease. The study contains 180 patients in which 45 in control group and 135 will be CKD individuals with stage 3 to stage 5 each stage consisting of 45 each. In all the subjects, serum sample was estimated for blood urea, creatinine, serum calcium and serum phosphorus by using fully automatic chemistry analyzer. Serum Vitamin D and parathyroid hormone are estimated by ELISA. GFR was estimated by the MDRD formula. Data was expressed by Mean ±SD. In the present study, the mean serum calcium and Vitamin D were decreased in stage 3, stage 4 and stage 5 compared with the control and it is statistically significant. The mean phosphorus and parathyroid hormone were increased in stage 3, stage 4 and stage 5 compared with control and it is statistically significant. There was a positive correlation between vitamin D and calcium, and also between parathyroid and Phosphorus. Whereas it showed a negative correlation between vitamin D and Phosphorus and also between Parathyroid and calcium. The assessment of these parameters will be helpful in preventing future risk and also helpful in better life and outcome.
References
Gooneratne IK, Ranaweera AK, Liyanarachchi NP, Gunawardane N, Lanerolle RD. Epidemiology of chronic kidney disease in a Sri Lankan population. Int J Diabetes Dev Ctries. 2008;28(2):60-4. doi: 10.4103/0973-3930.43101, PMID 19902050.
Singla P, Parkash AA, Lal H, Nanda S. Benefits of vitamin D supplementation in pregnancy for prevention of preeclampsia. Int J Pharm Biol Sci. 2012;2:144-50.
Singh AK, Farag YM, Mittal BV, Subramanian KK, Reddy SR, Acharya VN et al. Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol. 2013 Dec;14(1):114. doi: 10.1186/1471-2369-14-114, PMID 23714169.
Kavitha D. Knowledge, attitudes and practice regarding vitamin D deficiency among antenatal mothers. Int J Pharm Biol Sci. 2015;64:86-97.
Amdur RL, Feldman HI, Gupta J, Yang W, Kanetsky P, Shlipak M et al. Inflammation and progression of CKD: the CRIC study. Clin J Am Soc Nephrol. 2016 Sep 7;11(9):1546-56. doi: 10.2215/CJN.13121215, PMID 27340285.
Levey AS, Beto JA, Coronado BE, Eknoyan G, Foley RN, Kasiske BL et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation task force on cardiovascular disease. Am J Kidney Dis. 1998 Nov 1;32(5):853-906. doi: 10.1016/s0272-6386(98)70145-3, PMID 9820460.
Vaidya SR, Aeddula NR. Chronic renal failure. Treasure Island: StatPearls Publishing; 2020.
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global prevalence of chronic kidney disease—a systematic review and meta-analysis. PLOS ONE. 2016;11(7):e0158765. doi: 10.1371/journal.pone.0158765, PMID 27383068.
Lovre D, Shah S, Sihota A, Fonseca VA. Managing diabetes and cardiovascular risk in chronic kidney disease patients. Endocrinol Metab Clin North Am. 2018;47(1):237-57. doi: 10.1016/j.ecl.2017.10.006, PMID 29407054.
Feingold KR, Grunfeld C. Introduction to lipids and lipoproteins. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors Endotext. South. MA: Dartmouth Publishing; 2018.
Artaza JN, Mehrotra R, Norris KC. Vitamin D and the cardiovascular system. Clin J Am Soc Nephrol. 2009 Sep 1;4(9):1515-22. doi: 10.2215/CJN.02260409, PMID 19696220.
Melamed ML, Astor B, Michos ED, Hostetter TH, Powe NR, Muntner P. 25-Hydroxyvitamin D levels, race, and the progression of kidney disease. J Am Soc Nephrol. 2009 Oct 29:ASN-2009030283;20(12):2631-9. doi: 10.1681/ASN.2009030283, PMID 19875805.
Brewer LC, Michos ED, Reis JP, D Michos E, P Reis J. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr Drug Targets. 2011 Jan 1;12(1):54-60. doi: 10.2174/138945011793591617, PMID 20795937.
De Boer IH, Kestenbaum B, Shoben AB, Michos ED, Sarnak MJ, Siscovick DS. 25-hydroxyvitamin D levels inversely associate with risk for developing coronary artery calcification. J Am Soc Nephrol. 2009 Aug 1;20(8):1805-12. doi: 10.1681/ASN.2008111157, PMID 19443637.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999 Mar 16;130(6):461-70. doi: 10.7326/0003-4819-130-6-199903160-00002, PMID 10075613.
Llach F. Secondary hyperparathyroidism in renal failure: the trade-off hypothesis revisited. Am J Kidney Dis. 1995;25(5):663-79. doi: 10.1016/0272-6386(95)90541-3.
Martin KJ, González EA. Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol. 2007;18(3):875-85. doi: 10.1681/ASN.2006070771.
Kates DM, Sherrard DJ, Andress DL. Evidence that serum phosphate is independently associated with serum PTH in patients with chronic renal failure. Am J Kidney Dis. 1997;30(6):809-13. doi: 10.1016/s0272-6386(97)90086-x, PMID 9398125.
Hruska KA, Teitelbaum SL. Renal osteodystrophy. N Engl J Med. 1995;333(3):166-74. doi: 10.1056/NEJM199507203330307, PMID 7791820.
Fournier A, Moriniere P, Benhamida F et al. Use of alkaline calcium salts as phosphate binders in uremic patients. Kidney Int. 1992;38:550.
Silver J, Levi R. Cellular and molecular mechanisms of secondary hyperparathyroidism. Clin Nephrol. 2005;63(2):119-30. doi: 10.5414/CNP63119.
Slatopolsky E, Finch J, Denda M, Ritter C, Zhong M, Dusso A, et al. Phosphorus restriction prevents parathyroid gland growth. High phosphorus directly stimulates PTH secretion in vitro. J Clin Invest. 1996;97(11):2534-40. doi: 10.1172/JCI118701, PMID 8647946.
Fire A, Cox D, Fontaine B. Elevation of serum phosphate affects parathyroid hormone levels in only 50% of hemodialysis patients which is unrelated to serum calcium. J Am Soc Nephrol. 1993;3:1947.
Van holder R, Patels Hsu Ch. Effect of uric acid on plasma level of125 (OH)2D in renal failure. J Am Soc Nephrol. 1993;4:1035.
Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008;52(3):519-30. doi: 10.1053/j.ajkd.2008.03.020, PMID 18514987.
Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31(4):607-17. doi: 10.1053/ajkd.1998.v31.pm9531176, PMID 9531176.
Andress DL. ADynamic bone in patients with chronic kidney disease. Kidney Int. 2008;73(12):1345-54. doi: 10.1038/ki.2008.60, PMID 18337716.
Hruska KA, Mathew S, Lund R, Qiu P, Pratt R. Hyperphosphatemia of chronic kidney disease. Kidney Int. 2008;74(2):148-57. doi: 10.1038/ki.2008.130, PMID 18449174.
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