Vitamin D deficiency, insulin resistance, and ventricular hypertrophy in the early stages of chronic kidney disease

Abstract

Materials and methods:The study comprised 67 patients with CKD (eGFR ! 30 mL/min) and 15 healthy controls matched for age and sex. The phlogosis indexes, vit D levels, IR, carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured. Results: In our study, the mean value of LVMI and cIMT was significantly higher in patients with eGFR ! 30 mL/min compared with controls (p ¼ 0.037 and p50.001). The IR and intact parathyroid hormone (iPTH) levels were increased in CKD patients, whereas the serum levels of vit D were significantly reduced (p ¼ 0.044, p ¼ 0.012, p ¼ 0.038). A positive correlation was found between LVMI and IR (r ¼ 0.704, p ¼ 0.041) and a negative correlation was found between IR and vit D levels (r ¼ À0.238, p ¼ 0.031). Conclusions: In our study, IR and vit D deficiency were found to be independent predictors of left ventricular hypertrophy and atherosclerotic disease. Vitamin D deficiency and IR are thus associated with increased CV risk. More novel approaches to improving IR and vit D supplementation in the CKD population might lead to potential strategies for preventing excess CV mortality.

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

“…An increased iPTH level may be associated with left ventricular and vascular medial smooth muscle hypertrophy. Vitamin D deficiency, and/or increased iPTH, could, at least partially, explain hypertrophy of the left ventricle and proliferation of vascular smooth muscle cells, promoting atherosclerosis and endothelial dysfunction [39-40]. Vitamin D is also involved in glycemic control, insulin secretion, and sensitivity, partially explaining the negative correlation found in our study, between 25-OH-VitD and HOMA-IR (Fig.…”

“…Participants were studied with the high-resolution B-mode ultrasound machine Toshiba Aplio XV (Toshiba AplioxV, Toshiba American Medical Systems, Inc., Tustin, CA, USA) equipped with a 5- to 12-MHz linear transducer with a 0.01-mm resolution, following a standardized vascular protocol [25]. IMT was measured at three points on the far walls of both left and right distal common carotid arteries, carotid bulb, and the proximal portion of the internal carotid arteries.…”

Cardio-Renal Syndrome Type 4: The Correlation Between Cardiorenal Ultrasound Parameters

“…Insufficient Vitamin D receptor (VDRs) activation also may contribute to CRS type 4, indeed VDRs are expressed not only in the classical target organs but also in other non-classical targets including arteries, heart, immune system, endocrine organs, and nervous system. The myocardium is an important target of vitamin D and its deficiency predisposes to up-regulation of the RAAS and hypertrophy of ventricle and vascular smooth muscle cells, indeed VDRs knockout mice show myocardial renin overexpression and marked cardiomyocyte hypertrophy [21,22]. Vitamin D deficiency is associated with increased cardiovascular-related morbidity and mortality, possibly by modifying cardiac structure and function, but while its effects on the LV, have been extensively studied, little is known about its effects on the RV [23,24].…”

Early markers of cardiovascular risk in chronic kidney disease

“…Indeed vascular calcification and left ventricular hypertrophy (LVH) are the most commonly encountered clinical challenges and the most prevalent reasons for morbidity and mortality. [3][4][5] Nontraditional risk factors, such as hyperhomocysteinemia and hyperuricemia, have a high prevalence in renal disease and are associated with endothelial dysfunction and vascular damage. [6][7][8][9][10][11] Therefore, the identification of early markers of CVDs in this population is an important task for nephrologists.…”