Role of vitamin D3 in lipid metabolism and chronic pain in advanced diabetic kidney disease and its rehabilitation

Abstract

Background:Recently, the prevalence of type 2 diabetes has substantially increased, largely due to improvements in economic conditions and lifestyle changes. Type 2 diabetes disrupts carbohydrate and lipid metabolism, leading to damage to multiple organs, including the kidneys. Diabetic kidney disease (DKD) is a chronic microvascular complication of diabetes that can result in end-stage renal disease.
Objective:This study aimed to elucidate the biochemical factors involved in the diagnosis of DKD and their interrelationships for delaying the progression of DKD. The plasma levels of vitamin D, inflammatory factors, blood lipids, and complement were analyzed in patients with DKD. Furthermore, the risk factors and their relationship in patients with DKD were examined to provide clinical evidence for delaying the progression of DKD.Study design:Patients were divided into three groups according to urinary albumin-creatinine ratio (UACR). Group 1 comprised individuals with type 2 diabetes and normal microalbuminuria (stage A1), group 2 included those with type 2 diabetes and microalbuminuria (stage A2), and group 3 consisted of individuals with type 2 diabetes and macroalbuminuria (stage A3).
Methods:A total of 112 patients with type 2 diabetes who were hospitalized in the endocrinology department between July 2020 and December 2023 were selected in the study. The patients were divided into three groups based on their albuminuria status: the normal albuminuria group (A1, n=53; control group), the microalbuminuria group (A2, n=28), and the macroalbuminuria group (A3, n=31) groups. The fasting levels of vitamin D₃, blood lipids, UACR, inflammatory factors, complement, and glucose metabolism indices were measured and subjected to statistical analysis.
Results:Compared with the A1 group (with normal microalbuminuria), increased serum low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), erythrocyte sedimentation rate (ESR), visual analog scale (VAS) scores (P < 0.001, P=0.016, P < 0.001, and P < 0.001, respectively), and decreased high-density lipoprotein cholesterol (HDL-C) and vitamin D₃ levels (P=0.046 and P < 0.001, respectively) were found in the A2 and A3 groups. The UACR values in groups A2 and A3 were inversely proportional to serum vitamin D₃ levels (P < 0.001) and positively proportional to serum TG, LDL-C, and VAS scores (P=0.003, P=0.015, and P=0.005, respectively). A negative correlation was observed between vitamin D₃ and LDL-C levels (P=0.003). Further logistic regression analysis demonstrated that a decline in vitamin D₃ and elevations in LDL-C and TG levels were independent risk factors for DKD. The areas under the curve of serum vitamin D₃, LDL-C, and TG for predicting DKD with macroproteinuria were 0.79, 0.695, and 0.632, respectively.
Conclusion:The severity, pain, and lipid metabolism of patients with DKD are associated with vitamin D₃ levels. Serum vitamin D3 levels were identified as a highly predictive factor for the development of DKD with macroproteinuria.

Keywords

Diabetic kidney disease / Vitamin D₃ / Lipid metabolism / Chronic pain

Ethics approval

The study followed the principles of the Declaration of Helsinki as revised in 2013, and proved by the Medical Ethics Committee of Yan'an University School of Medicine (Ethics Batch Number: 2020-33). Written informed consent was obtained from all participants. This manuscript has the consent of the participant for the use of his/her data and for the publication of the data that appear in the article.

Funding

This research received no external funding.

CRediT authorship contribution statement

Ning-Ning Zhuang: Writing-review & editing, Writing-original draft, Visualization, Methodology, Formal analysis, Data curation, Conceptualization, Investigation. Hao-Jun You: Writing-review & editing, Supervision, Funding acquisition. All the authors have read and approved the final version of this manuscript.

Declaration of Competing Interest

The authors declare that they have no competing interests.

Acknowledgments

The present work was supported by the project from the Key Laboratory of Yan'an Sports Rehabilitation Medicine.

Appendix A. Supplementary material

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.hcr.2024.100005.

Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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