Vitamin D Insufficiency with Elevated ADMA and hs-CRP: A Single-center Study of Chronic Kidney Disease Patients Undergoing Hemodialysis
Abstract
Background: Vitamin D deficiency is a common issue among patients with chronic kidney disease (CKD) due to its ability to convert vitamin D into the active form of calcitriol, which is crucial for controlling cell inflammation. Low vitamin D levels are associated with increased inflammation and higher levels of biomarkers such as c-reactive protein and asymmetric dimethylarginine as an endogenous inhibitor of nitric oxide synthase. Those two combined become a specific marker for cardiovascular diseases, which become one of the common causes of CKD mortality.
Objective: This study examines the correlation between vitamin D insufficiency, elevated high-sensitivity c-reactive protein, and asymmetric dimethylarginine in CKD patients receiving hemodialysis.
Methods: This study used a cross-sectional design of CKD patients receiving hemodialysis in Dr. Kariadi Central General Hospital, Semarang, Indonesia, in November 2021. Thirty-six patients were randomly enrolled after meeting inclusion and exclusion criteria. Primary outcomes of Vitamin D, hs-CRP, and ADMA were measured from patients’ blood after hemodialysis. A statistical analysis of Pearson's correlation was used for primary outcomes.
Results: No significant difference was found in the patient's baseline characteristics. A significant correlation between vitamin D and ADMA has been found; however, no correlation between vitamin D and hs-CRP has been found
Conclusion: Vitamin D deficiency is correlated with elevated ADMA, indicative of endothelial dysfunction.
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References
Borg R, Carlson N, Søndergaard J, Persson F. The Growing Challenge of Chronic Kidney Disease: An Overview of Current Knowledge. Int J Nephrol. 2023;2023:9609266. doi: 10.1155/2023/9609266
Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(7):473-85. doi: 10.1038/s41581-024-00820-6
Hidayangsih PS, Tjandrarini DH, Sukoco NEW, Sitorus N, Dharmayanti I, Ahmadi F. Chronic kidney disease in Indonesia: evidence from a national health survey. Osong Public Health Res Perspect. 2023;14(1):23–30. doi: 10.24171/j.phrp.2022.0290
Elendu C, Elendu RC, Enyong JM, Ibhiedu JO, Ishola IV, Egbunu EO, et al. Comprehensive review of current management guidelines of chronic kidney disease. Medicine. 2023;102(23):e33984. doi: 10.1097/MD.0000000000033984
Yamada S, Nakano T. Role of Chronic Kidney Disease (CKD)–Mineral and Bone Disorder (MBD) in the Pathogenesis of Cardiovascular Disease in CKD. J Atheroscler Thromb. 2023;30(8):835–50. doi: 10.5551/jat.RV22006
Marassi M, Fadini GP. The cardio-renal-metabolic connection: a review of the evidence. Cardiovasc Diabetol. 2023;22(1):195. doi: 10.1186/s12933-023-01937-x
Kadatane SP, Satariano M, Massey M, Mongan K, Raina R. The Role of Inflammation in CKD. Cells. 2023;12(12):1581. doi: 10.3390/cells12121581
Qu L, Jiao B. The Interplay between Immune and Metabolic Pathways in Kidney Disease. Cells. 2023;12(12):1584. doi: 10.3390/cells12121584
Badura K, Janc J, Wąsik J, Gnitecki S, Skwira S, Młynarska E, et al. Anemia of Chronic Kidney Disease—A Narrative Review of Its Pathophysiology, Diagnosis, and Management. Biomedicines. 2024;12(6):1191. doi: 10.3390/biomedicines12061191
Rodríguez MAÁ, Moreno IAV, Alvarado HAG, Ugalde VFP, Mendoza VYN, Melgoza EG. Cardiac Stress in Chronic Kidney Disease: Unraveling the Myocardial Paradox. IJMSCRS. 2023;3(10):2461–7. doi: 10.47191/ijmscrs/v3-i10-64
Capelli I, Cianciolo G, Gasperoni L, Galassi A, Ciceri P, Cozzolino M. Nutritional vitamin D in CKD: Should we measure? Should we treat? Clin Chim Acta. 2020;501:186–97. doi: 10.1016/j.cca.2019.11.010
Martínez-Arias L, Panizo S, Alonso-Montes C, Martín-Vírgala J, Martín-Carro B, Fernández-Villabrille S, et al. Effects of calcitriol and paricalcitol on renal fibrosis in CKD. Nephrol Dial Transplant. 2021;36(5):793–803. doi: 10.1093/ndt/gfaa373
Chen N-C, Hsu C-Y, Mao PC-M, Dreyer G, Wu F-Z, Chen C-L. The effects of correction of vitamin D deficiency on arterial stiffness: A systematic review and updated meta-analysis of randomized controlled trials. J Steroid Biochem Mol Biol. 2020;198:105561. doi: 10.1016/j.jsbmb.2019.105561
Pinto RD, Wright JT, Monaco A, Pietropaoli D, Ferri C. Vitamin D and blood pressure control among hypertensive adults: results from NHANES 2001–2014. J Hypertens. 2020;38(1):150–8. doi: 10.1097/HJH.0000000000002231
Kim D-H, Meza CA, Clarke H, Kim J-S, Hickner RC. Vitamin D and Endothelial Function. Nutrients. 2020;12(2):575. doi: 10.3390/nu12020575
Dey SK, Kumar S, Rani D, Maurya SK, Banerjee P, Verma M, et al. Implications of vitamin D deficiency in systemic inflammation and cardiovascular health. Crit Rev Food Sci Nutr. 2023;2023:1–18. doi: 10.1080/10408398.2023.2224880
Avci E, Karabulut A, Alp AG, Baba B, Bilgi C. Crucial markers showing the risk of coronary artery disease in obesity: ADMA and neopterin. J Med Biochem. 2020;39(4):452–9. doi: 10.5937/jomb0-24683
Schrauben SJ, Anderson AH, Hsu C-y, Ix JH, Shafi T, Shlipak M, et al. Higher Plasma ADMA Levels and Lower ADMA and SDMA Fractional Excretion Were Associated With Risk of Atherosclerotic Cardiovascular Disease in Diabetic Kidney Disease: TH-PO238. Journal of the American Society of Nephrology. 2022;33(11S):115. doi: 10.1681/ASN.20223311S1115a
Hsu H-J, Wu I-W, Hsu K-H, Sun C-Y, Chen C-Y, Lee C-C. Vitamin D deficiency, cardiothoracic ratio, and long-term mortality in hemodialysis patients. Sci Rep. 2020;10(7533). doi: 10.1038/s41598-020-64359-9
Lim YJ, Sidor NA, Tonial NC, Che A, Urquhart BL. Uremic Toxins in the Progression of Chronic Kidney Disease and Cardiovascular Disease: Mechanisms and Therapeutic Targets. Toxins. 2021;13(2):142. doi: 10.3390/toxins13020142
Gorska-Ciebiada M, Ciebiada M. Association of hsCRP and vitamin D levels with mild cognitive impairment in elderly type 2 diabetic patients. Exp Gerontol. 2020;135:110926. doi: 10.1016/j.exger.2020.110926
Hariri Z, Kord-Varkaneh H, Alyahya N, Prabahar K, Găman M-A, Abu-Zaid A. Higher Dietary Vitamin D Intake Influences the Lipid Profile and hs-CRP Concentrations: Cross-Sectional Assessment Based on The National Health and Nutrition Examination Survey. Life. 2023;13(2):581. doi: 10.3390/life13020581
Fassula AS, Gonzalez-Chica D, Giehl MC, Silva DAS, Cembranel F, Moreno YMF. Moderator role of vitamin D concentrations on the association between metabolic syndrome and C-reactive protein among adults. Arch Endocrinol Metab. 2021;64(6):695-703. doi: 10.20945/2359-3997000000272
Kandelouei T, Abbasifard M, Imani D, Aslani S, Razi B, Fasihi M, et al. Effect of Statins on Serum level of hs-CRP and CRP in Patients with Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Mediators Inflamm. 2022;2022:8732360. doi: 10.1155/2022/8732360
Denegri A, Boriani G. High Sensitivity C-reactive Protein (hsCRP) and its Implications in Cardiovascular Outcomes. Curr Pharm Des. 2021;27(2):263–75. doi: 10.2174/1381612826666200717090334
Zhang X, Cui L, Chen B, Xiong Q, Zhan Y, Ye J, et al. Effect of chromium supplementation on hs-CRP, TNF-α and IL-6 as risk factor for cardiovascular diseases: A meta-analysis of randomized-controlled trials. Complement Ther Clin Pract. 2021;42:101291. doi: 10.1016/j.ctcp.2020.101291
Lee C, Park KH, Joo YS, Nam KH, Chang T-I, Kang EW, et al. Low High‐Sensitivity C‐Reactive Protein Level in Korean Patients With Chronic Kidney Disease and Its Predictive Significance for Cardiovascular Events, Mortality, and Adverse Kidney
Outcomes: Results From KNOW‐CKD. J Am Heart Assoc. 2020;9(21):e017980. doi: 10.1161/JAHA.120.017980
Wu L, Liu Y, Wu L, Yang J, Jiang T, Li M. Effects of exercise on markers of inflammation and indicators of nutrition in patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol. 2022;54(4):815–26. doi: 10.1007/s11255-021-02949-w
Kahraman E, Ayan D, Arıcıoğlu A, Akmansu M. Effect of Vitamin D supplementation on symmetric dimethyl arginine, asymmetric dimethyl arginine, homocysteine levels in rats being exposed to gamma radiation. Asian J Med Sci. 2021;12(1):8–13. doi: 10.3126/ajms.v12i1.31548
Hsu C-N, Tain Y-L. Asymmetric Dimethylarginine (ADMA) in Pediatric Renal Diseases: From Pathophysiological Phenomenon to Clinical Biomarker and Beyond. Children. 2021;8(10):837. doi: 10.3390/children8100837
Wee CL, Mokhtar SS, Singh KKB, Rasool AHG. Vitamin D deficiency attenuates endothelial function by reducing antioxidant activity and vascular eNOS expression in the rat microcirculation. Microvasc Res. 2021;138(104227). doi: 10.1016/j.mvr.2021.104227
Wee CL, Mokhtar SS, Singh KKB, Yahaya S, Leung SWS, Rasool AHG. Calcitriol Supplementation Ameliorates Microvascular Endothelial Dysfunction in Vitamin D-Deficient Diabetic Rats by Upregulating the Vascular eNOS Protein Expression and Reducing Oxidative Stress. Oxid Med Cell Longev. 2021;2021:3109294. doi: 10.1155/2021/3109294
Renke G, Starling-Soares B, Baesso T, Petronio R, Aguiar D, Paes R. Effects of Vitamin D on Cardiovascular Risk and Oxidative Stress. Nutrients. 2023;15(3):769. doi: 10.3390/nu15030769
Uberti F, Lattuada D, Morsanuto V, Nava U, Bolis G, Vacca G, et al. Vitamin D Protects Human Endothelial Cells From Oxidative Stress Through the Autophagic and Survival Pathways. The Journal of Clinical Endocrinology & Metabolism. 2014;99(4):1367–74. doi: 10.1210/jc.2013-2103
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