Progression of diabetic nephropathy and vitamin D serum levels: A pooled analysis of 7722 patients.

Safaa Ahmed, Hani Aiash, Mohamed Alazmy, Yusef Hazimeh, Yousef Tanas, Tamer Mady, Abdelrahman Elsayed, Abhinav Arora, Aryan Arora, Ahmed Elsayed, Hana M Samir, Yomna E Dean, Mohamed Yasser Habash, Waleed Yasser Habash, Prashant Obed Reddy Dundi, Tharun Reddi, Haya Ashraf, Arinnan Chotwatanapong, Ahmed A Salem, Wangpan Shi, Sameh Samir Elawady

Journal: Endocrinology, diabetes & metabolism 2023;6(6):e453

PMID: 37743677

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Abstract

BACKGROUND AND AIM

Low serum Vitamin D levels have been associated with diabetic nephropathy (DN). Our study aimed to analyse the serum levels of vitamin D in patients suffering from DN and the subsequent changes in serum vitamin D levels as the disease progresses.

METHODS

PubMed, Embase, SCOPUS and Web of Science were searched using keywords such as '25 hydroxyvitamin D' and 'diabetic nephropathy'. We included observational studies that reported the association between the serum 25 hydroxy vitamin D levels and diabetic nephropathy without restriction to age, gender, and location. R Version 4.1.2 was used to perform the meta-analysis. The continuous outcomes were represented as mean difference (MD) and standard deviation (SD) and dichotomous outcomes as risk ratios (RR) with their 95% confidence interval (CI).

RESULTS

Twenty-three studies were included in our analysis with 7722 patients. Our analysis revealed that vitamin D was significantly lower in diabetic patients with nephropathy than those without nephropathy (MD: -4.32, 95% CI: 7.91-0.74, p-value = .0228). On comparing diabetic patients suffering from normoalbuminuria, microalbuminuria, or macroalbuminuria, we found a significant difference in serum vitamin D levels across different groups. Normoalbuminuria versus microalbuminuria showed a MD of -1.69 (95% CI: -2.28 to -1.10, p-value = .0002), while microalbuminuria versus macroalbuminuria showed a MD of (3.75, 95% CI: 1.43-6.06, p-value = .0058), proving that serum vitamin D levels keep declining as the disease progresses. Notwithstanding, we detected an insignificant association between Grade 4 and Grade 5 DN (MD: 2.29, 95% CI: -2.69-7.28, p-value = .1862).

CONCLUSION

Serum Vitamin D levels are lower among DN patients and keep declining as the disease progresses, suggesting its potential benefit as a prognostic marker. However, on reaching the macroalbuminuria stage (Grades 4 and 5), vitamin D is no longer a discriminating factor.

Address: Faculty of Medicine, Alexandria University, Alexandria, Egypt.; Neuro-endovascular Surgery Department, Medical University of South Carolina, Charleston, South Carolina, USA.; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Faculty of Medicine, Suez Canal University, Ismailia, Egypt.; Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.; Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas, USA.; Karnataka Institute of Medical Sciences, Rajiv Gandhi University of Health Sciences, Bengaluru, India.; New Giza University, Giza, Egypt.; Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt.; Syracuse University, Syracuse, New York, USA.; College of Medicine, Royal College of Surgeons, Dublin, Ireland.; International American University, College of Medicine, Vieux Fort, Saint Lucia.; Lebanese University, Beirut, Lebanon.; Zahraa Hospital, University Medical Center, Beirut, Lebanon.; Medical director, Dhaman Health Assurance Company, Kuwait, Kuwait.; SUNY Upstate Medical University, Syracuse, New York, USA.

DOI: 10.1002/edm2.453

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MeSH Terms: Humans, Diabetic Nephropathies, Vitamin D, Albuminuria, Diabetes Mellitus