Secondary hyperparathyroidism in chronic kidney disease in patients with diabetes mellitus: the role of vitamin D deficiency

   BACKGROUND: Vitamin D deficiency in secondary hyperparathyroidism (SHPT) against the background of chronic kidney disease (CKD) in patients with diabetes mellitus (DM) is one of the key factors in the deterioration of renal function.

   AIM. To assess the indicators of calcium-phosphorus metabolism in individuals with SHPT against the background of CKD, diabetes and without it to optimize treatment approaches.

   MATERIALS AND METHODS. A retrospective analysis of 416 medical records with diagnoses CKD3-C5 and SHPT was carried out, of which 112 had a history of diabetes, which were examined and treated in the nephrology department of the in the period from 01. 01. 2018 to 31. 12. 2022. Demographic and anthropometric data were studied, laboratory (total and ionized calcium, total protein, albumin, phosphorus, creatinine, parathyroid hormone, 25(OH)D, alkaline phosphatase) and instrumental (ECHO-CG, ultrasound of the abdominal organs and retroperitoneal space) research methods.

   RESULTS. Diabetes is the leading cause of CKD among all nosological forms. The level of 25(OH)D in patients without diabetes varied from 9.04 to 152 nmol/l, with diabetes from 8.3 to 77 nmol/l. The average level of 25(OH)D in patients without diabetes (41.7 ± 26.1 nmol/l) was significantly higher than in patients with type 1 diabetes (20.3 ± 14.9 nmol/l) and type 2 diabetes (27.6 ± 19.2 nmol/l) (p = 0.005 and p = 0.003, respectively). 25(OH)D deficiency and insufficiency were more often recorded in patients with diabetes compared with patients without carbohydrate disorders (89 % and 10 % versus 69 % and 19 % respectively), while the optimal level was more common in patients without diabetes (12 % and 1 %, respectively).

1. https://kdigo.org/wp-content/uploads/2019/07/KDIGO_2018-Annual-Report.pdf. Electronic resource (accessed 03. 10. 2023)

2. Rumyantseva E.I. Chronic kidney disease as a global public health problem: dynamics of morbidity and mortality. Problemy standartizacii v zdravoohranenii = Health care Standardization Problems. 2021(1-2):41-49. (in Russ.). doi: 10.26347/1607-2502202101-02041-049

3. Dedov II, Shestakova MV, Vikulova OK, et al. Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01. 01. 2021. Diabetes mellitus. 2021;24(3):204-221. (In Russ.). doi: 10.14341/DM12759

4. Chaudhuri А, Ghanim H, Arora P. Improving residual risk of renal and cardiovascular outcomes in dkd: review of pathophysiology, mechanisms and evidence from recent trials. Diabetes Obes Metab. 2022;24(3):365-376. doi: 10.1111/dom.14601

5. George C, Echouffo-Tcheugui JB, Jaar BG, et al. The need for screening, early diagnosis, and prediction of chronic kidney disease in people with diabetes in low-and-middle income countries-a review of the current literature. BMC Med. 2022;20(1):247. doi: 10.1186/s12916-022-02438-6

6. Kidney Disease: Improving Global Outcomes (KDIGO) CD-MBD Work Group. 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):1. doi: 10.1016/j.kisu.2017.04.001

7. Egshatyan LV, Mokrisheva NG. Secondary hyperparathyroidism in patient with type 2 diabetes and stages 3–4 chronic kidney disease. Diabetes mellitus. 2018;21(2):128-134. (In Russ.). doi: 10.14341/DM9458

8. https://kdigo.org/wp-content/uploads/2022/12/Russian-Translation-KDIGO-2021-Glomerular-Diseases-Guideline.pdf.] Electronic resource (accessed 03. 10. 2023)

9. https://euat.ru/education/calculator-egfr. Electronic resource (accessed 03. 10. 2023)

10. Bobkova IN, Vatazin AV, Vetchinnikova ON, i dr. // Klinicheskie rekomendacii associacii nefrologov. Hronicheskaya bolezn' pochek (HBP). 2023 g.: 233S. (In Russ.).

11. Dedov II, Mel'nichenko GA, Belaya ZhE, i dr. Klinicheskie rekomendacii Rossijskoj associacii endokrinologov po deficitu vitamina D. 2021: 61 S. (In Russ.).

12. Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. The Lancet. 2018;392:2052–2090. doi: 10.1016/S0140-6736(18)31694-5

13. International Diabetes Federation. IDF Diabetes Atlas, 10^th edn. Brussels, Belgium:International Diabetes Federation, 2021.

14. Tervaert Thijs W Cohen, Mooyaart Antien L, Amann Kerstin, et al. On behalf of the Renal Pathology Society. Pathologic Classification of Diabetic Nephropathy. Journal of the American Society of Nephrology. 2010;21(4):556-563. doi: 10.1681/ASN.2010010010

15. Liu Q, Sun J, Xu T, Bian G, Yang F. Associations of serum amyloid A and 25‐hydroxyvitamin D with diabetic nephropathy: A cross‐sectional study. J Clin Lab Anal. 2022;36(3). doi: 10.1002/jcla.24283

16. Zhou T, Shen L, Li Z, et al. Severe 25-Hydroxyvitamin D Deficiency May Predict Poor Renal Outcomes in Patients With Biopsy-Proven Diabetic Nephropathy. Front Endocrinol (Lausanne). 2022;13. doi: 10.3389/fendo.2022.871571

17. Ray S, Beatrice AM, Ghosh A, et al. Profile of chronic kidney disease related-mineral bone disorders in newly diagnosed advanced predialysis diabetic kidney disease patients: A hospital based cross-sectional study. Diabetes Metab Syndr Clin Res Rev. 2017;11:S931-S937. doi: 10.1016/j.dsx.2017.07.019

18. Duan S, Lu F, Wu B, et al. Association of Serum 25 (OH) Vitamin D With Chronic Kidney Disease Progression in Type 2 Diabetes. Front. Endocrinol. 2022;13:929598. doi: 10.3389/fendo.2022.929598

19. Xu F, Lu H, Lai T, et al. Chen Y. Association between Vitamin D Status and Mortality among Adults with Diabetic Kidney Disease. J. Diabetes Res. 2022;2022:9632355. doi: 10.1155/2022/9632355

20. Xiao X, Wang Y, Hou Y, et al. Vitamin D deficiency and related risk factors in patients with diabetic nephropathy. J. Int. Med. Res. 2016;44:673–684. doi: 10.1177/0300060515593765.

21. Jamal Shahwan M, Hassan NAG, Shaheen RA. Assessment of kidney function and associated risk factors among type 2 diabetic patients. Diabetes Metab. Syndr. 2019;13:2661–2665. doi: 10.1016/j.dsx.2019.07.025

22. Wang Y, Yang S, Zhou Q, et al. Effects of Vitamin D Supplementation on Renal Function, Inflammation and Glycemic Control in Patients with Diabetic Nephropathy : A Systematic Review and Meta-Analysis. Kidney Blood Press Res. 2019;44:72–87. doi: 10.1159/000498838

23. Friedl C, Zitt E. Vitamin D prohormone in the treatment of secondary hyperparathyroidism in patients with chronic kidney disease. Int J Nephrol Renovasc Dis, 10 (2017), pp. 109-122. doi 10.2147/IJNRD.S97637

24. Cardoso MP, Pereira LAL. Native vitamin D in pre-dialysis chronic kidney disease. Nefrologia (Engl Ed). 2019;39(1):18-28. English, Spanish. doi: 10.1016/j.nefro.2018.07.004