Insulin resistance and vitamin D deficiency in patients with chronic kidney disease stage 2-3

Department of Clinical and Experimental Pharmacotherapy, Slovak Medical University, Bratislava, Slovakia.
Physiological research / Academia Scientiarum Bohemoslovaca (Impact Factor: 1.29). 10/2010; 60(1):149-55.
Source: PubMed


Vitamin D status and the relationship between serum 25(OH) vitamin D concentrations and the components of insulin resistance were examined in 120 patients with chronic kidney disease stage 2 and 3. Insulin sensitivity/resistance was calculated by the quantitative insulin sensitivity check index (QUICKI). In this analysis, the prevalence of insulin resistance was 42 %. Only 17 % of patients had serum 25(OH) vitamin D concentration in the recommended range (>/=30 ng/ml), 42 % suffered from vitamin D insufficiency and 41 % had moderate vitamin D deficiency. Insulin resistance significantly correlated with serum 25(OH)D and 1,25(OH)(2)D concentrations, renal function and protein excretion rate. Our results support the increasing evidence that vitamin D deficiency may be one of the factors participating in the development of insulin resistance already in the early stages of chronic kidney disease.

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    • "Epidemiological and prospective studies have proposed an inverse relationship between vitamin D status and risk of developing diabetes, insulin resistance (IR), and metabolic syndrome [5] [6] [7] [8] [9] [10]. "
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    ABSTRACT: The objectives of the study were to determine associations between single nucleotide polymorphisms (SNPs) of the vitamin D receptor (VDR) gene and insulin resistance and the effects of these SNPs on changes in insulin sensitivity in response to vitamin D supplementation. The research described here was an extension of the Surya study. Genotyping of the Cdx-2, FokI, BsmI, ApaI, and TaqI SNPs was carried out on 239 South Asian women in New Zealand using polymerase chain reaction-based techniques. Associations of these genotypes and 3' end haplotypes with insulin resistance were determined using multiple regression analysis. Associations between SNP genotypes and responses in insulin sensitivity to vitamin D supplementation (4000 IU vitamin D(3) per day) were also determined for a subset (81) of these women. BsmI BB, ApaI AA, and TaqI tt genotypes were significantly associated with lower insulin resistance compared with BsmI bb, ApaI aa, and TaqI TT, respectively, in the cohort of 239 women. Furthermore, homozygosity of the haplotypes baT and BAt was associated with higher and lower insulin resistance, respectively, compared with no copies of their respective alleles. Of the 81 subjects who were supplemented with vitamin D, women with the FokI Ff genotype showed a significantly greater improvement in insulin sensitivity (increase of 29.4 [2.9, 38.1]) compared with women with the FokI FF genotype (increase of 2.3 [-11.5, 10.1]). This study has highlighted the association of vitamin D responsiveness and insulin resistance with VDR gene polymorphisms. This is the first study to determine associations between all three. Genotyping of the VDR gene may provide a predictive measure for insulin resistance in response to vitamin D intervention.
    Metabolism: clinical and experimental 08/2011; 61(3):293-301. DOI:10.1016/j.metabol.2011.06.018 · 3.89 Impact Factor
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    ABSTRACT: Patients with chronic kidney disease (CKD) are often insufficient in 25(OH) vitamin D and are almost uniformly deficient in 1,25(OH)2 vitamin D, because of decreased renal hydroxylation resulting from hyperphosphatemia and elevated fibroblast growth factor-23 (FGF-23) levels. These same abnormalities lead to secondary hyperparathyroidism for which the administration of calcitriol or vitamin D analogs has been the mainstay of therapy for decades. This review summarizes new trials of vitamin D, calcitriol, and its analogs over the last 2 years. In addition to the endocrine effects of the vitamin D axis on bone and mineral metabolism, studies have demonstrated there is also extrarenal conversion of 25(OH) vitamin D to 1,25(OH)2 vitamin D in multiple cells leading to autocrine effects. This advance has led to the speculation that CKD patients may also need to be supplemented with ergocalciferol or cholecalciferol. Unfortunately, to date, the majority of interventional studies have focused on biochemical end points. There are no randomized controlled trials demonstrating that therapy with any formulation of vitamin D results in improved patient level outcomes. Despite the physiologic importance of vitamin D in health and disease, more research is required to determine which vitamin D derivative is required for optimal health in CKD patients.
    Current opinion in nephrology and hypertension 07/2011; 20(4):354-9. DOI:10.1097/MNH.0b013e3283470450 · 3.96 Impact Factor
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    ABSTRACT: Recent data has shown that vitamin D increases insulin sensitivity; however, there is little evidence about the effects of this treatment on elderly people with impaired fasting glucose. The aim of the present study was to investigate the effect of vitamin D treatment on insulin sensitivity and metabolic parameters in elderly people with impaired fasting glucose. A total of 28 elderly patients were enrolled into the vitamin D treatment group. The control group included 23 age-, sex- and body mass index-matched elderly participants. The vitamin D treatment group was treated with vitamin D(3) according to serum concentrations of 25(OH)D. With supplementation, 96.0% of patients achieved a mean serum 25(OH)D concentration of 123.2 ± 59.9 nmol/L. After 4.7 ± 2.5 months of treatment, there was a significant decrease in homeostasis model assessment of insulin resistance, insulin and glucose concentrations in the vitamin D treatment group (P = 0.007, P = 0.007, P = 0.037, respectively). Vitamin D treatment significantly increased high-density lipoprotein cholesterol (P = 0.037), but did not cause statistically significant differences in other lipid parameters. We found that vitamin D treatment might modify insulin sensitivity in the elderly with impaired fasting glucose.
    Geriatrics & Gerontology International 12/2011; 12(3):454-60. DOI:10.1111/j.1447-0594.2011.00791.x · 2.19 Impact Factor
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