Study On The Correlation Between 25 (OH) D Levels And Kidney Diseases

Background:Chronic kidney disease (CKD) as the world’s epidemic of chronic disease, with insidious onset, slow development, if not timely diagnosis and treatment, the disease will rapidly progress to chronic renal failure (End Stage renal Disease, ESRD) uremia.Disturbances in calcium and phosphorus metabolism are almost invariable consequences of chronic kidney disease.Long term calcium and phosphorus metabolism disorders in chronic kidney disease can lead to hyperparathyroidism,mineral and bone disease,immune dysfunction,metastatic calcification, reduced quality of life and survival of patients.In this study,we collected 363 cases of chronic kidney disease and 66 cases of healthy person. Through statistical analysis,our aim is to investigate the relationship values with different stages CKD.patients with CKD blood 25-hydroxyvitamin D levels and related factors;detecting different CKD blood 25-hydroxyvitamin D levels,Understand the different CKD and vitamin D correlation.Understand the relationship between CKD and different stages CKD between 25-hydroxyvitamin D from a clinical point of view, to guide clinical vitamin D supplementPart one The vitamin D levels of Chronic kidney disease and related influencing factorsObjectives.To understand the serum leve of 25-hydroxy-vitamin D [25(OH)D] between different stages of chronic kidney disease (stage CKD 1-5 non-dialysis) and to understand the 25-hydroxy-vitamin D [25(OH)D] deficiency and lack of conditions between different stages of chronic kidney disease by detecting the level of serum 25(OH)D in CKD patients. To explore the related effect factors 25(OH)D deficiency in CKD patients, and provide guide for clinical vitamin D supplement through factor analysis.Methods:Collect patients diagnosed with chronic kidney disease from February 2014 to February 2015 in the second affiliated hospital of Kunming Medical College. The inclusion criteria:patients diagnosed with chronic kidney disease according to the guidelines defined by United States Foundation for kidney disease in 2005;collect a total of 119 cases. CKD1 31 group cases, CKD2 group 22 cases, CKD3 group 18cases, CKD4 group 24 cases, CKD5 group 30 cases,66 healthy people for healthy control group. Collect the following general information of the group members:gender, age, height, weight, duration of kidney disease-related history. Test subjects’blood albumin (Alb), prealbumin, alkaline phosphatase (Alp), blood urea nitrogen (Bun), creatinine (Scr), calcium (Ca) and phosphorus (P), glucose (Glu), red blood cell (Rbc), hemoglobin (Hb) and other parameters. Test serum Osteocalcin calcitonin (CT) levels by RIA method,and test serum intact parathyroid hormone (iPTH) and 25(OH)D levels by chemiluminescence immunoassay methed.The diagnostic criteria of serum 25(OH)D level seted by K/DOQI’s:30ng/mL<25(OH)D is the normal vitamin D; 20ng/mL≤25(OH)D<30ng/mL prompt vitamin d insufficient; 10ng/mL≤25(OH)D<20ng/mL prompt vitamin d deficiency; 0ng/mL≤25(OH)D<10 ng/mL prompt serious vitamin d deficiency.Compared the different 25(OH)D level between the groups and analyzed the correlation between its deficiency and other measurements. Analyzed the datea using SPSS 19.0, the data in accordance with normal distribution of measurement said by mean ± standard deviation, the groups were compared by one-way analysis of variance, count data were compared with the x2 test. Correlation analysis used Pearson correlation analysis, analyzed factors affecting vitamin D by multivariate linear regression analysis, prompt the difference was statistically significant(p<0.05).Results:The serum 25 (OH) in CKD1 period patients content for 20.36 ± 4.99 (ng/ml), CKD2 content for 19.21± 5.78 (ng/ml), CKD3 content for 18.14 ± 4.84 (ng/mL), CKD4 content for 16.74 ±7.19 (ng/mL), CKD5 15.44 ± 7.49 (ng/ml), the serum 25(OH)D levels of 1-5 chronic kidney disease patients compared with the control group,difference is significant (P<0.01); The difference of serum 25(OH)D levels between CKD1 stage and CKD4 stage, CKD5 stage is significant (P<0.05); The difference of serum 25(OH)D levels between CKD2 stage and CKD5 stage is significant (P<0.05). CKD1 period insufficient rate of 25(OH)D is 64.5%, and lack rate is 32.3%,CKD2 insufficient rate of 25(OH)D is 22.7%, and lack rate is 68.2%,CKD3 period insufficient rate of 25(OH)D is 33.3%, and lack rate is 66.7%,CKD4 period insufficient rate of 25(OH)D is 37.5%, and lack rate is 62.5%,CKD5 period insufficient rate of 25(OH)D is 13.5%, and lack rate is 81.1%. The serum 25(OH)D level of CKD patients is negative related with blood muscle anhydride level (r=-0.245, and p<0.01); it is negative related with parathyroid hormone level(r=-0.216, and p<0.01); it is significantly negative related with urea nitrogen level(r=-0.23, and p<0.01); it is negative related with p level(r=-0.194, and p<0.05); it is negative related with drop calcium pigment level (r=-0.171, and p<0.05); it is positive related with eGFR(r=0.471, and p<0.001); it is positive related with hemoglobin (r=0.33, and p<0.001); it is positive related with blood innocent protein (r=0.335, and p<0.001); it is positive related with albumin (r=0.335、 p<0.001); it is positive related with calcium (r=0.283, and p<0.01); it is positive related with RBC (r=0.366,P<0.001)。The following factors leading to the regression equation:albumin (t=5.439, p=0.000), prealbumin (t=-3.575, p=0.000), gender (t=-2.610, p=0.010), red blood cells (t=3.389, p=0.001), glucose (t=3.122, p=0.002), BMI (t=-2.002, p=0.048),the equation is Y=-9.288+-2.610xsex+3.389xRed+5.439xalbumin+3.122xblood glucose-2.002xBMI.Conclusion:The serum 25(OH)D level gradually declined with the progress of CKD,the lack rate constantly increased; the serum 25(OH)D level of CKD patients is negative related with blood muscle anhydride、parathyroid hormone、urea nitrogen、 P、drop calcium pigment level; and is positive related with eGFR、hemoglobin、white protein、calcium and RBC; albumin、prealbumin、gender、RBC、glucose and BMI are independent effects factors to the level of 25(OH)D.Part two The vitamin D levels of Chronic kidney disease and related influencing factors different kidney disease correlationObjectives:Through observation and comparison of diabetic nephropathy (Diabetic nephropathy, DN), primary nephrotic syndrome (primary nephrotic syndrome, PNS), lupus nephritis (Lupus nephritis, LN), chronic renal failure and uremia (End-stage renal disease ESRD) peritoneal dialysis and hemodialysis patients and healthy controls serum 25 (OH) vitamin D (25-Hydroxyvitamin D) level, lack of understanding of the different chronic kidney disease and a lack of vitamin D, so as to guide clinical vitamin D supplement.Methods:Collect patients diagnosed with chronic kidney disease from February 2014 to February 2015 in the second affiliated hospital of Kunming Medical College. The inclusion criteria:《 1999 WHO diagnostic criteria for diabetes》 and 《2013 edition Chinese Diabetes Prevention Guide》 diagnosis of diabetic nephropathy,《1999 WHO diagnostic criteria for diabetes》 and 《2013 edition Chinese Diabetes Prevention Guide》 diagnosis of diabetic nephropathy, 《1997 American College of Rheumatology classification criteria for SLE recommended》 Diagnosis of lupus nephritis, 《Nephrology》 Primary nephrotic syndrome and renal dialysis patients diagnosed. collect a total of 244 cases,Diabetic nephropathy (DN) 53 cases,lupus nephritis (LN) 42 cases,primary nephrotic syndrome (PNS) 37 cases,peritoneal dialysis (PD) 69 cases,hemodialysis (HD) 43 cases.66 healthy people for healthy control group. Collect the following general information of the group members:gender, age, height, weight, duration of kidney disease-related history. The diagnostic criteria of serum 25(OH)D level seted by K/DOQI’s:30ng/mL≤25(OH)D is the normal vitamin D; 20ng/mL≤25(OH)D<30ng/mL prompt vitamin d insufficient; 10ng/mL≤5(OH)D<20ng/mL prompt vitamin d deficiency; 0ng/mL≤25(OH)D<10ng/mL prompt serious vitamin d deficiency Compared the different 25(OH)D level between the groups. Analyzed the datea using SPSS 19.0, the data in accordance with normal distribution of measurement said by mean ± standard deviation, the groups were compared by one-way analysis of variance,count data were compared with the x2 test, prompt the difference was statistically significant(p<0.05).Results:Patients in each group compared with the control group, kidney disease serum 25(OH)D levels were significantly reduced (P<0.001). The serum 25 (OH) in DN period patients content for 16.46±8.04 (ng/ml),LN content for 13.12±8.35 (ng/ml),NS content for 9.29±5.51(ng/mL), PD content for 10.33±4.78(ng/mL), HD content for 14.47±8.10(ng/mL), the serum 25(OH)D levels of different kidney disease patients compared with the control group difference is significant (P<0.01), The difference of serum 25(OH)D levels between DN stage and LN stage, PD stage,NS stage is significant (P<0.01), The difference of serum 25(OH)D levels between PD stage and LN stage, HD stage is significant (P<0.05), The difference of serum 25(OH)D levels between LN stage and, NS stage is significant (P<0.01), The difference of serum 25(OH)D levels between NS stage and, HD stage is significant (P<0.001). healthy control group Normal of 25(OH)D is 4.5%, period insufficient rate 87.9%, and lack rate is 7.6%; DN group Normal of 25(OH)D is 3.8%, period insufficient rate 30.2%, and lack rate is 37.7%, A serious lack of rate 28.3%; NS group period insufficient rate of 25(OH)D is 8.1%, and lack rate is 32.4%, A serious lack of rate 59.5%; LN group period insufficient rate of 25(OH)D is 28.6%, and lack rate is 21.4%, A serious lack of rate 50%; PD group period insufficient rate of 25(OH)D is 4.4%, and lack rate is 35.3%, A serious lack of rate 60.3%; HD group Normal of 25(OH)D is 4.7%, period insufficient rate 20.9%, and lack rate is 41.9%, A serious lack of rate 32.6%;Conclusion:Kidney disease patients with different levels of vitamin D from low to high:PNS PD,LN HD DN, group; vitamin D deficiency rate descending order: PD,PNS,HD,LN,DN.