Analysis Of The Relationship Between Serum 25-hydroxyvitaminD And Diabetic Kidney Disease In Patients With Type 2 Diabetes Mellitus

ObjectiveThe levels of 25-hydroxy vitamin D(25-(OH)D)and urinary biomarkers related to glomerular and renal tubules in hospitalized patients with type 2 diabetes mellitus(T2DM)were collected to study the changes of 25-(OH)D in different stages of diabetic kidney disease(DKD)and the relationship between 25-(OH)D and urinary IgG and THP,so as to explore the relationship between serum 25-(OH)D and DKD in patients with T2DM.MethodThis study was a retrospective study.993 patients with T2DM patients were selected from the Endocrinology Department of the first affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital)from December 2018 to December 2019,and 663 patients were included according to the exclusion criteria.The clinical data were collected,including demographic data and laboratory results(Urinary Albumin to Creatinine Ratio(UACR),urinary THP,urinary IgG,serum 25-(OH)D.According to the level of UACR,the patients were divided into macroalbuminuria group(≥300mg/g)microalbuminuria group(30-300mg/g)and normal albuminuria group(<30mg/g).The patients were divided into high filtration group 1(eGFR≥140ml/min/1.73m2),normal filtration group 2(eGFR 60-140ml/min/1.73m2)and low filtration group 3(eGFR<60ml/min/1.73m2)according to the level of eGFR.According to the level of 25-(OH)D,the patients were divided into normal group(≥20ng/ml)and deficiency group(<20ng/ml).25-(OH)D and other clinical data were compared among groups,and the relationship between 25-(OH)D and urinary albuminuiria,THP and IgG was analyzed.ResultsThe study included 663 patients with type 2 diabetes,375 males(56.6%)and 288 females(43.4%).Including 405(61.1%)patients with normal proteinuria,193(29.1%)patients with microalbuminuria and 65(9.8%)patients with large proteinuria.The proportion of vitamin D deficiency in the normal albuminuria group and the microalbuminuria group was significantly lower than that in the large proteinuria group(54.6%61.1%vs 86.2%,P<0.01).The course of disease in the albuminuria group was significantly higher than that in the non-albuminuria group;the age,SBP and prevalence rate of hypertension in the normal albuminuria group were significantly lower than those in the macroalbuminuria group and microalbuminuria group(P<0.01),and the TG in the normal albuminuria group was lower than that in the microalbuminuria group.The prevalence rate of hypertension,SBP,TC and TG in the macroalbuminuria group were higher than those in the microalbuminuria group;There was a significant difference in urinary IgG among the three groups(P<0.01),which was the highest in the macroalbuminuria group and the lowest in the normoalbuminuria group.Serum 25-(OH)D and urinary THP in normal albuminuria group and microalbuminuria group were significantly higher than those in macroalbuminuria group(P<0.01).The level of eGFR was the highest in the normal albuminuria group and the lowest in the massive albuminuria group,there was significant difference among the three groups(P<0.01).Age,course of disease,prevalence of hypertension,Scr and UACR were significant difference among the three groups(P<0.01),and they were highest in low filtration group,the lowest in high filtration group.The level of 25-(OH)D in low filtration group and normal filtration group was significantly lower than that in high filtration group,and the difference was statistically significant(P<0.05).eGFR and urinary THP were positively correlated with 25-(OH)D(P<0.05),while UACR and urinary IgG were negatively correlated with serum 25-(OH)D(P<0.05).Binary Logistic regression analysis showed that serum 25-(OH)D was a factor affecting the occurrence of DKD.ConclusionThe incidence of 25-(OH)D deficiency in DKD patients with macroalbuminuria,and serum 25-(OH)D deficiency is an independent risk factor for DKD.