Renal function decline and impact on vitamin D levels, parathyroid hormone and control of calcemia and phosphataemia
DOI:
https://doi.org/10.33448/rsd-v11i15.37394Keywords:
Renal function; Vitamin D; Parathyroid hormone; Calcium; Phosphorus.Abstract
This study is descriptive where the initial population was 7,895 patients, being first characterized according to the reference of each exam and classified in below, within and above the reference intervals. Then, those who performed, together, the dosages of vitamin D, creatinine and eGFR were filtered, for which the median, standard deviation, minimum and maximum were calculated, in addition to the classification into six groups, according to KDIGO (Kidney Disease: Improving Global Outcomes), considering the gender variable. For each group, the results of vitamin D were statistically analyzed, in which a significant difference was observed for males with p = 0.032 between G1 and G2 and p = 0.0012 between G1 and G3a, and no significant difference was observed for females . Standard and mean deviations were also calculated for the other tests in order to compare the results between the groups, an increase in the mean of PTH levels was noted as the GFR worsened, that is, G1 = 44.76 pg/mL (±10 .99); G2 = 61.63pg/mL (±24.93); G3a = 62.1 (±43.95); G3b = 65.5 pg/mL (±42.71); G4 = 94.11 pg/mL (±67.97); G5 = 464.5 (±529.63). The results show that there is a renal influence on hormone-mineral metabolism, due to increased PTH levels with the worsening of CKD and fluctuation in vitamin D levels, however many of the evaluated patients have other medical conditions, such as heart disease, diabetes, among others, in addition to the use of medication, or even vitamin D replacement, which can influence the results of the exams.
References
Bastos, M. G., Bregman, R., & Kirsztajn, G. M. (2010). Doença renal crônica: frequente e grave, mas também prevenível e tratável. Revista da Associação Médica Brasileira, 56, 248-253.
Castro, L. C. G. D. (2011). O sistema endocrinológico vitamina D. Arquivos Brasileiros de Endocrinologia & Metabologia, 55, 566-575.
Centeno, P. P., Herberger, A., Mun, H. C., Tu, C., Nemeth, E. F., Chang, W., & Ward, D. T. (2019). Phosphate acts directly on the calcium-sensing receptor to stimulate parathyroid hormone secretion. Nature communications, 10(1), 1-12.
Cobo, G., Lindholm, B., & Stenvinkel, P. (2018). Chronic inflammation in end-stage renal disease and dialysis. Nephrology Dialysis Transplantation, 33(suppl_3), iii35-iii40.
Colcha, H. S. M., Llapapasca, S. D. P., Angamarca, M. J. D., & Saraguro, D. G. M. (2020). Hiperparatiroidismo secundario insuficiencia renal. RECIMUNDO, 4(4), 282-290.
Christakos, S., Li, S., De La Cruz, J., & Bikle, D. D. (2019). New developments in our understanding of vitamin D metabolism, action and treatment. Metabolism, 98, 112-120.
de Boer, I. H., Caramori, M. L., Chan, J. C., Heerspink, H. J., Hurst, C., Khunti, K., & Rossing, P. (2020). KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney international, 98(4), S1-S115.
Dusse, L. M. S., Rios, D. R. A., Sousa, L. P. N., Morais, R. M., Domingueti, C. P., & Borges, K. B. G. (2017). Biomarcadores da função renal: do que dispomos atualmente? Revista Brasileira de Análise Clínicas.
Estrela, C. (2018). Metodologia científica: ciência, ensino, pesquisa. Artes Médicas.
Ferreira, C. E. S., Maeda, S. S., Batista, M. C., Lazaretti-Castro, M., Vasconcellos, L. S., Madeira, M., & Moreira, C. A. (2017). Consensus-reference ranges of vitamin D [25 (OH) D] from the Brazilian medical societies. Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) and Brazilian Society of Endocrinology and Metabolism (SBEM). Jornal Brasileiro de Patologia e Medicina Laboratorial, 53, 377-381.
Gembillo, G., Cernaro, V., Salvo, A., Siligato, R., Laudani, A., Buemi, M., & Santoro, D. (2019). Role of vitamin D status in diabetic patients with renal disease. Medicina, 55(6), 273.
Guibu, I. A., Moraes, J. C. D., Guerra, A. A., Costa, E. A., Acurcio, F. D. A., Costa, K. S., & Álvares, J. (2017). Main characteristics of patients of primary health care services in Brazil. Revista de Saúde Pública, 51.
Goltzman, D., Mannstadt, M., & Marcocci, C. (2018). Physiology of the calcium-parathyroid hormone-vitamin D axis. Vitamin D in Clinical Medicine, 50, 1-13.
Inda Filho, A. J., & Melamed, M. L. (2013). Vitamina D e doença renal: o que nós sabemos e o que nós não sabemos. Brazilian Journal of Nephrology, 35, 323-331.
Jacquillet, G., & Unwin, R. J. (2019). Physiological regulation of phosphate by vitamin D, parathyroid hormone (PTH) and phosphate (Pi). Pflügers Archiv-European Journal of Physiology, 471(1), 83-98.
Levey, A. S., Coresh, J., Tighiouart, H., Greene, T., & Inker, L. A. (2020). Measured and estimated glomerular filtration rate: current status and future directions. Nature Reviews Nephrology, 16(1), 51-64.
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. L., Castro, A. F., 3rd, Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., Coresh, J., & CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009). A new equation to estimate glomerular filtration rate. Annals of internal medicine, 150(9), 604–612.
Lombardi, G., Ziemann, E., Banfi, G., & Corbetta, S. (2020). Physical activity-dependent regulation of parathyroid hormone and calcium-phosphorous metabolism. International journal of molecular sciences, 21(15), 5388.
Malta, D. C., Machado, Í. E., Pereira, C. A., Figueiredo, A. W., Aguiar, L. K. D., Almeida, W. D. S. D., & Szwarcwald, C. L. (2019). Avaliação da função renal na população adulta brasileira, segundo critérios laboratoriais da Pesquisa Nacional de Saúde. Revista Brasileira de Epidemiologia, 22.
Murton, M., Goff-Leggett, D., Bobrowska, A., Garcia Sanchez, J. J., James, G., Wittbrodt, E., & Tuttle, K. (2021). Burden of chronic kidney disease by KDIGO categories of glomerular filtration rate and albuminuria: a systematic review. Advances in therapy, 38(1), 180-200.
Sampaio, E. D. A., Lugon, J. R., & Barreto, F. D. C. (2008). Fisiopatologia do hiperparatireoidismo secundário. J. Bras. Nefrol., 30(1 suppl. 1), 6-10.
Sassi, F., Tamone, C., & D’Amelio, P. (2018). Vitamin D: nutrient, hormone, and immunomodulator. Nutrients, 10(11), 1656.
Scholz, H., Boivin, F. J., Schmidt-Ott, K. M., Bachmann, S., Eckardt, K. U., Scholl, U. I., & Persson, P. B. (2021). Kidney physiology and susceptibility to acute kidney injury: implications for renoprotection. Nature Reviews Nephrology, 17(5), 335-349.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Maria Olivia Amaral Tavares; Sergio Henrique Nascente Costa; Thalyta Renata Araújo Santos Rodrigues; Isabela Cinquini Junqueira
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.