Relationship Between 25-hydroxyvitamin D₃ And Metabolic Syndrome In Maintenance Hemodialysis Patients

Objectives:To explore the relationship between 25-hydroxyvitamin D₃ and metabolic syndrome in maintenance hemodialysis patients.Methods:1.All the patients were collected from the outpatient and inpatient departments of the Blood Purification Center of the Second Hospital of Tianjin Medical University from October 2015 to January 2017.Inclusion criteria:Patients had regular hemodialysis for longer than 3 months.Exclusion criteria:Patients who was unable to stand up to measure height,weight and waist circumference;had acute infections,malignant tumors and severe liver function abnormalities;underwent parathyroidectomy or amputation surgery.A total of 143 patients were included in our study.2.Patients’demographic data were collected:gender,age,height,body mass index（BMI）and abdominal circumference.Clinical biochemical parameters were collected:serum total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,very low-density lipoprotein cholesterol（VLDL-C）,low-density lipoprotein cholesterol（LDL-C）,triglyceride（TG）,aspartate aminotransferase（AST）,serum creatinine（Cr）,alanine aminotransferase（ALT）,urea nitrogen（BUN）,and albumin（Alb）.3.The metabolic syndrome was defined by the International Diabetes Federation（IDF）criteria.The serum 25（OH）D₃ was measured by chemiluminescence instrument/United States.Patients with different serum25（OH）D₃ concentrations were grouped according to the K/DOQI（Nephrology Prognosis Quality Initiative）guidelines:patients with serum 25（OH）D₃concentrations>30μg/L were recruited into the adequate group;serum 25（OH）D₃concentration of 15 to 30μg/L were recruited into the deficient group;patients with a serum 25（OH）D₃ concentration of less than 15μg/L were recruited into the deficient group.4.All statistical analyses were conducted with the Statistical Package for the Social Sciences（SPSS）version 20.0.Multivariate Logistic regression analysis was used to analyze the influencing factors of MS in MHD patients.After adjusting for major possible confounding factors such as serum uric acid and serum phosphorus,multivariate Logistic regression analysis was used to analyze the relationship between Serum 25（OH）D₃ Concentration and Metabolic Syndrome in MHD patients.After adjusting for possible confounding factors such as sex,age,and body mass index,the relationship between 25（OH）D₃ and abnormal metabolic factors in MHD patients was analyzed using binary multivariate Logistic regression analysis.A bilateral P value of less than 0.05 was considered statistically significant.Results:The average serum 25（OH）D₃ level was 24.30μg/L,and the prevalence of metabolic syndrome was 53.1%（65 patients）.The prevalence of hypertension was83.92%;the prevalence of lowering of high-density lipoprotein cholesterol（HDL-C）was 76.22%.The average concentration of 25（OH）D₃ in MS patients was lower than that in non-MS patients（18.89±7.85μg/L vs.25.96±7.97μg/L）,and the difference was statistically significant（P<0.001）.The prevalence of metabolic syndrome was higher in 25（OH）D₃ deficiency group than in 25（OH）D₃ deficiency group and sufficient group,and the prevalence of metabolic syndrome was lower in 25（OH）D₃group.Compared with patients in the adequate group（73.17%vs.44.93%vs.39.09%）,there was a statistically significant difference between the groups（P<0.001）.The patient’s abdominal circumference and serum triacylglycerol increased with the increase of 25（OH）D₃ deficiency（all P<0.05）;the body mass index of 25（OH）D₃ deficiency and deficiency group was higher than that of adequate group（all P<0.05）;lack of systolic blood pressure,triglyceride,fasting blood glucose were higher in patients with adequate and inadequate groups,high-density lipoprotein was lower than adequate and inadequate group patients（all P<0.05）.The more metabolic abnormalities the patient had,the lower the concentration of25（OH）D₃ was（P<0.001）.Serum 25（OH）D₃ concentration was negatively correlated with the occurrence of MS（OR=0.889,95%CI:0.846 to 0.934,P<0.001）,but also with the occurrence of central obesity（OR=0.913,95%CI:0.874 to 0.953,P<0.001）,elevated triglyceride（OR=0.932,95%CI:0.894 to 0.971,P=0.001）,and decreased high-density lipoprotein（OR=0.901,95%CI:0.845 to 0.959,P=0.001）,increased systolic blood pressure（OR=0.898,95%CI:0.847 to 0.953,P<0.001）and fasting blood glucose（OR=0.956,95%CI:0.920 to 0.994,P=0.024）were negative Related.Conclusions:1.The prevalence of metabolic syndrome in maintenance hemodialysis patients is high.In these patients,hypertension is the most common factor,followed by decreased high-density lipoprotein.2.MHD patients generally have low levels of serum 25-hydroxyvitamin D₃.Low levels of serum 25-hydroxyvitamin D₃ is an independent risk factor for metabolic syndrome in maintenance hemodialysis patients.The prevalence of metabolic syndrome increases with the degree of serum 25-hydroxyvitamin D₃ deficiency.3.Low levels of serum 25-hydroxyvitamin D₃ are independent risk factors for central obesity,elevated triglyceride levels,decreased high-density lipoprotein cholesterol,elevated fasting blood glucose levels,and elevated systolic blood pressure in maintenance hemodialysis patients.The number of abnormal metabolic factors was negatively correlated with serum 25-hydroxyvitamin D₃ levels.Serum 25-hydroxyvitamin D₃ levels in maintenance hemodialysis patients are associated with the severity of metabolic abnormalities.