Kolekalsiferol sonrası endotel disfonksiyonu ve damar sertliğinin diyaliz modalitesine göre değerlendirilmesi
Öz
Amaç: Özellikle serum 25-hidroksivitamin D (25OHD) seviyeleri düşük kronik böbrek hastalığı (KBH) olan çocuklarda kardiyovasküler hastalık(KVH) gelişme riski önemli ölçüde artmaktadır. Bu çalışmada; KBH olan ve hemodiyaliz(HD), periton diyalizi(PD) ve diyaliz dışı (ND) tedavi alan çocuklarda D vitamini eksikliğinin etkilerini ve kolekalsiferol tedavisinin endotel fonksiyonları ve damar sertliği üzerine olan etkilerini karşılaştırmayı amaçladık
Yöntem: 25OHD düzeyi düşük toplam 41 çocuktan oluşan 7HD, 7 PD ve 27 ND hasta grupları; 300.000 ünite tek doz oral kolekalsiferol öncesi ve sonrası biyokimyasal parametreler, akım aracılı dilatasyon (FMD) ve lokal arter sertliği açısından kendi aralarında karşılaştırıldı.
Bulgular: D vitamini takviyesi öncesi HD, PD ve ND hasta grupları arasında FMD ve lokal arteryel sertlik değerlerinde farklılık yoktu. Kolekalsiferol tedavisi sonrası tüm hasta gruplarında endotel bağımlı FMD ‘de önemli artış gözlendi; ancak endotel bağımsız FMD ve lokal arteryel sertlik ölçümlerinde iyileşme sadece PD ve ND hastalarında gösterildi. Diyaliz olan hastalarda (HD, PD) başlangıç parathormon düzeyi daha yüksekti; çalışma sonunda ise sadece diyalize girmeyen hasta grubunda anlamlı azalma olduğu tespit edildi.
Sonuç: KBH olan ve 25OHD düzeyi düşük çocuklarda hastalığın şiddetine bakılmaksızın endotel fonksiyon bozukluğu ve artmış damar sertliği saptanmıştır. Kolekalsiferol tedavisi ile gözlenen iyileşme, KVH gelişimini önlemek için D vitamini eksikliğinin KBH ‘nın erken evrelerinde bile düzeltilmesi gerektiğini ortaya koymuştur.
Anahtar Kelimeler
Damar sertliği endotel disfonksiyonu kronik böbrek hastalığı kolekalsiferol
Kaynakça
- 1. Parekh RS, Carrol CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatrics. 2002;141:191-197.
- 2. Rostand SG, Drueke TB. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int. 1999;56:383–392.
- 3. Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR. Left ventricular mass and systolic performance in pediatric patients with chronic renal failure. Circulation. 2003;107:864 – 868.
- 4. Kari JA, Donald AE, Vallance DT, et al. Physiology and biochemistry of endothelial function in children with chronic renal failure. Kidney Int. 1997;52: 468-72.
- 5. London GM, Guerin AP, Verbeke FH, et al. Mineral metabolism and arterial functions in end-stage renal disease: Potential role of 25-hydroxyvitamin D deficiency. J Am Soc Nephrol. 2007;18: 613-620.
- 6. Muscheites J, Meyer AA, Drueckler E, et al. Assessment of the cardiovascular system in pediatric chronic kidney disease: a pilot study. Pediatr Nephrol. 2008;23:2233-2239.
- 7. Chitalia N, Recio-Mayoral A, Kaski JC, Banerjee D. Vitamin D deficiency and endothelial dysfunction in non-dialysis chronic kidney disease patients. Atherosclerosis. 2012;220:265-268.
- 8. Patange AR, Valentini RP, Du W, Pettersen MD. Vitamin D deficiency and arterial wall stiffness in children with chronic kidney disease. Pediatr Cardiol. 2012;33:122-128.
- 9. Matias PJ, Jorge C, Ferreira C, et al. Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters. Clin J Am Soc Nephrol. 2010;5: 905-91.
- 10. Wakasugi M, Noguchi T, Inoue M, et al. Vitamin D3 stimulates the production of prostacyclin by vascular smooth muscle cells. Prostaglandins. 1991;42:127-13.
- 11. Stubbs JR, Idiculla A, Slusser J, Menard R, Quarles LD. Cholecalciferol supplementation alters calcitriol-responsive monocyte proteins and decreases inflammatory cytokines in ESRD. J Am Soc Nephrol. 2010;21:353-361.
- 12. National Kidney Foundation K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis. 2005;46:S1-S121.
- 13. Devreux RB, Reichec N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55:613-618.
- 14. De Simone G, Daniels SR, Devreux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol. 1992;20:1251-1260.
- 15. Celermajer DS, Sorensen KE, Gooch VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111-1115.
- 16. Pannier B, Guerin AP, Marchais SJ, Metivier F, Safar ME, London GM. Postischemic vasodilation, endothelial activation, and cardiovascular remodeling in end-stage renal disease. Kidney Int. 2007;57:1091-1099.
- 17. Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with endstage renal disease who are undergoing dialysis. N Engl J Med. 2000;342:1478–1483.
- 18. Chavers BM, Li S, Collins AJ, Herzog CA. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int. 2002;62:648–653.
- 19. Jablonski KL, Chonchol M, Pierce GL, Walker AE, Seals SR. 25-Hydroxyvitamin D deficiency is associated with inflammation-linked vascular endothelial dysfunction in middleaged and older adults. Hypertension. 2011;57:63–69.
- 20. Passauer J, Pistrosch F, Büssemaker E, Lassig G, Herbrig K, Gross P. Reduced agonist-induced endothelium-dependent vasodilation in uremia is attributable to an impairment of vascular nitric oxide. J Am Soc Nephrol. 2005;16:959 –965.
- 21. Zoccali C, Bode-Boger S, Mallamaci F, et al. Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: A prospective study. Lancet. 2001;358:2113-2117.
- 22. Chitalia N, Ismail T, Tooth L, et al. Impact of vitamin D supplementation on arterial vasomotion, stiffness and endothelial biomarkers in chronic kidney disease. PLos ONE. 2014;9(3):e91363.doi:10.1371.
- 23. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38:938 –942.
- 24. Guerin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcification in end-stage renal disease. Nephrol Dial Transplant. 2000;15:1014–1021.
- 25. Shroff R, Egerton M, Bridel M, et al. A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol. 2008;19:1239–1246.
- 26. Marckmann P, Agerskov H, Thineshkumar S, et al. Randomized controlled trial of cholecalciferol supplementation in chronic kidney disease patients with hypovitaminosis D. Nephrol Dial Transplant. 2012;27:3523-3531.
- 27. Oh J, Wunsch R, Turzer M, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation. 2002;106:100–105.
- 28. Kalkwarf HJ, Denburg MR, Strife CF, et al. Vitamin D deficiency is common in children and adolescents with chronic kidney disease. Kidney Int. 2012;81:690-697.
- 29. Kim HW, Park CW, Shin YS, et al. Calcitriol regresses cardiac hypertrophy and QT dispersion in secondary hyperparathyroidism on hemodialysis. Nephron Clin Pract. 2006;102:21–9.
- 30. Sandgren ME, Bronnegard M, DeLuca HF. Tissue distribution of the 1, 25-dihydroxyvitamin D3 receptor in the male rat. Biochem Biophys Res Commun. 1991;181:611–6.
Assessment of endothelial dysfunction and vascular stiffness after cholecalciferol according to dialysis modality
Öz
ABSTRACT
Objective: The risk of developing cardiovascular disease (CVD) increases significantly in children with chronic kidney disease (CKD) especially with low serum 25- hydroxyvitamin D (25OHD) levels. Herein; we aimed to compare the effects of vitamin D deficiency and the impact of cholecalciferol treatment on endothelial functions and vascular stiffness in children with CKD receiving hemodialysis (HD), peritoneal dialysis (PD) and non- dialysis(ND).
Methods: 7 HD, 7 PD and 27 ND patient groups consisting of 41 children totally with low 25OHD levels were compared among each other in regards of biochemical parameters, flow-mediated dilatation(FMD) and local arterial stiffness before and after a single dose of 300.000 units of cholecalciferol treatment.
Results: There was no difference in FMD and local arterial stiffness values between HD, PD and ND patient groups before vitamin D supplementation. Significant increase in endothelium-dependent FMD was observed in all patient groups after intervention with cholecalciferol; however the improvement in endothelium-independent FMD and local arterial stiffness measurements was demonstrated in patients with PD and ND. Baseline parathormon level was higher in patients on dialysis; at the end of the study, significant decrease was detected only in patient group not receiving diaysis.
Conclusions: Endothelial dysfunction and impaired vascular stiffness were determined in children with CKD with low 25OHD levels regardless of the disease severity.. Recovery with cholecalciferol therapy revealed that vitamin D deficiency should be corrected even in early stages of CKD to prevent the development of CVD
Anahtar Kelimeler
Vascular stiffness endothelial dysfunction chronic kidney disease cholecalciferol
Kaynakça
- 1. Parekh RS, Carrol CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatrics. 2002;141:191-197.
- 2. Rostand SG, Drueke TB. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int. 1999;56:383–392.
- 3. Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR. Left ventricular mass and systolic performance in pediatric patients with chronic renal failure. Circulation. 2003;107:864 – 868.
- 4. Kari JA, Donald AE, Vallance DT, et al. Physiology and biochemistry of endothelial function in children with chronic renal failure. Kidney Int. 1997;52: 468-72.
- 5. London GM, Guerin AP, Verbeke FH, et al. Mineral metabolism and arterial functions in end-stage renal disease: Potential role of 25-hydroxyvitamin D deficiency. J Am Soc Nephrol. 2007;18: 613-620.
- 6. Muscheites J, Meyer AA, Drueckler E, et al. Assessment of the cardiovascular system in pediatric chronic kidney disease: a pilot study. Pediatr Nephrol. 2008;23:2233-2239.
- 7. Chitalia N, Recio-Mayoral A, Kaski JC, Banerjee D. Vitamin D deficiency and endothelial dysfunction in non-dialysis chronic kidney disease patients. Atherosclerosis. 2012;220:265-268.
- 8. Patange AR, Valentini RP, Du W, Pettersen MD. Vitamin D deficiency and arterial wall stiffness in children with chronic kidney disease. Pediatr Cardiol. 2012;33:122-128.
- 9. Matias PJ, Jorge C, Ferreira C, et al. Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters. Clin J Am Soc Nephrol. 2010;5: 905-91.
- 10. Wakasugi M, Noguchi T, Inoue M, et al. Vitamin D3 stimulates the production of prostacyclin by vascular smooth muscle cells. Prostaglandins. 1991;42:127-13.
- 11. Stubbs JR, Idiculla A, Slusser J, Menard R, Quarles LD. Cholecalciferol supplementation alters calcitriol-responsive monocyte proteins and decreases inflammatory cytokines in ESRD. J Am Soc Nephrol. 2010;21:353-361.
- 12. National Kidney Foundation K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis. 2005;46:S1-S121.
- 13. Devreux RB, Reichec N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55:613-618.
- 14. De Simone G, Daniels SR, Devreux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol. 1992;20:1251-1260.
- 15. Celermajer DS, Sorensen KE, Gooch VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111-1115.
- 16. Pannier B, Guerin AP, Marchais SJ, Metivier F, Safar ME, London GM. Postischemic vasodilation, endothelial activation, and cardiovascular remodeling in end-stage renal disease. Kidney Int. 2007;57:1091-1099.
- 17. Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with endstage renal disease who are undergoing dialysis. N Engl J Med. 2000;342:1478–1483.
- 18. Chavers BM, Li S, Collins AJ, Herzog CA. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int. 2002;62:648–653.
- 19. Jablonski KL, Chonchol M, Pierce GL, Walker AE, Seals SR. 25-Hydroxyvitamin D deficiency is associated with inflammation-linked vascular endothelial dysfunction in middleaged and older adults. Hypertension. 2011;57:63–69.
- 20. Passauer J, Pistrosch F, Büssemaker E, Lassig G, Herbrig K, Gross P. Reduced agonist-induced endothelium-dependent vasodilation in uremia is attributable to an impairment of vascular nitric oxide. J Am Soc Nephrol. 2005;16:959 –965.
- 21. Zoccali C, Bode-Boger S, Mallamaci F, et al. Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: A prospective study. Lancet. 2001;358:2113-2117.
- 22. Chitalia N, Ismail T, Tooth L, et al. Impact of vitamin D supplementation on arterial vasomotion, stiffness and endothelial biomarkers in chronic kidney disease. PLos ONE. 2014;9(3):e91363.doi:10.1371.
- 23. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38:938 –942.
- 24. Guerin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcification in end-stage renal disease. Nephrol Dial Transplant. 2000;15:1014–1021.
- 25. Shroff R, Egerton M, Bridel M, et al. A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol. 2008;19:1239–1246.
- 26. Marckmann P, Agerskov H, Thineshkumar S, et al. Randomized controlled trial of cholecalciferol supplementation in chronic kidney disease patients with hypovitaminosis D. Nephrol Dial Transplant. 2012;27:3523-3531.
- 27. Oh J, Wunsch R, Turzer M, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation. 2002;106:100–105.
- 28. Kalkwarf HJ, Denburg MR, Strife CF, et al. Vitamin D deficiency is common in children and adolescents with chronic kidney disease. Kidney Int. 2012;81:690-697.
- 29. Kim HW, Park CW, Shin YS, et al. Calcitriol regresses cardiac hypertrophy and QT dispersion in secondary hyperparathyroidism on hemodialysis. Nephron Clin Pract. 2006;102:21–9.
- 30. Sandgren ME, Bronnegard M, DeLuca HF. Tissue distribution of the 1, 25-dihydroxyvitamin D3 receptor in the male rat. Biochem Biophys Res Commun. 1991;181:611–6.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Çocuk Sağlığı ve Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2023 |
| Gönderilme Tarihi | 26 Ekim 2022 |
| Kabul Tarihi | 29 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 6 Sayı: 2 |
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