Objective To investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and novel inflammatory markers in maintenance hemodialysis (MHD) patients. Methods A total of 153 MHD patients were enrolled in this study. Patients were divided into three groups according to the serum 25(OH)D level: 25(OH)D deficiency group (serum 25(OH)D＜20ng/ml, n=50), 25(OH)D insufficiency group (serum 25(OH)D 20～30ng/ml, n=57), and 25(OH)D normal group (serum 25(OH)D >30ng/ml, n=46). The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), monocyte to high-density lipoprotein cholesterol ratio (MHR) and C-reactive protein to albumin ratio (CAR) were calculated. Spearman correlation analysis and linear regression analysis were used to define differences of the parameters among groups. Results The three groups showed statistical differences of age (F=4.061, P=0.019), diabetes (c2=6.982, P=0.030), diastolic blood pressure (F=3.200, P=0.044), serum albumin (F=8.744, P＜0.001), serum creatinine (F=3.844, P=0.024), total cholesterol (F=3.392, P=0.036), low-density lipoprotein cholesterol (F=3.296, P=0.040), NLR (F=5.633, P=0.004), MLR (F=7.569, P=0.001) and MHR (F=4.568, P=0.012). Serum 25(OH)D level was negatively correlated with age (r=−0.261, P=0.001), NLR (r=−0.261, P=0.001), MLR (r=−0.302, P<0.001), MHR (r=−0.256, P=0.002) and CAR (r=−0.179, P=0.029), and was positively correlated with diastolic blood pressure (r=0.227, P=0.005), albumin (r=0.207, P＜0.001), creatinine (r=0.288, P＜0.001), calcium (r=0.161, P=0.048), phosphorus (r=0.164, P=0.044), total cholesterol (r=0.241, P=0.004) and low-density lipoprotein cholesterol (r=0.241, P=0.004). Multivariate linear regression revealed that male gender (β=3.445, P=0.033), diabetes (β=-4.233, P=0.014), diastolic blood pressure (β=0.158, P=0.013), albumin (β=0.584, P=0.013), NLR (β=-1.351, P=0.001) and MHR (β=-6.894, P=0.032) were independently associated with serum 25(OH)D level. Conclusions Serum 25(OH)D level is negatively correlated with NLR, MLR, MHR and CAR, in which NLR and MHR are independently correlated with serum 25(OH)D levels. Serum 25(OH)D level is closely related to the inflammatory status in MHD patients.
[1] Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review[J]. Lancet, 2015,385(9981):1975-1982.
[2] Wakasugi M, Kazama J J, Narita I. Mortality trends among Japanese dialysis patients, 1988-2013: a joinpoint regression analysis[J]. Nephrol Dial Transplant, 2016,31(9):1501-1507.
[3] Wanner C, Zimmermann J, Schwedler S, et al. Inflammation and cardiovascular risk in dialysis patients[J]. Kidney Int Suppl, 2002(80):99-102.
[4] Blair D, Byham-Gray L, Lewis E, et al. Prevalence of vitamin D [25(OH)D] deficiency and effects of supplementation with ergocalciferol (vitamin D2) in stage 5 chronic kidney disease patients[J]. J Ren Nutr, 2008,18(4):375-382.
[5] Zhang Y, Darssan D, Pascoe E M, et al. Vitamin D status and mortality risk among patients on dialysis: a systematic review and meta-analysis of observational studies[J]. Nephrol Dial Transplant, 2018,33(10):1742-1751.
[6] Haddad Kashani H, Seyed Hosseini E, Nikzad H, et al. The Effects of Vitamin D Supplementation on Signaling Pathway of Inflammation and Oxidative Stress in Diabetic Hemodialysis: A Randomized, Double-Blind, Placebo-Controlled Trial[J]. Front Pharmacol, 2018,9:50.
[7] Mohiuddin S A, Marie M, Ashraf M, et al. Is there an association between Vitamin D level and inflammatory markers in hemodialysis patients? A cross-sectional study[J]. Saudi J Kidney Dis Transpl, 2016,27(3):460-466.
[8] Mirchi E, Saghafi H, Gharehbeglou M, et al. Association Between 25-Hydroxyvitamin D Level and Inflammatory and Nutritional Factors in Hemodialysis and Peritoneal dialysis Patients in Qom, Iran[J]. Iran J Kidney Dis, 2016,10(4):205-212.
[9] National Kidney F. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease[J]. Am J Kidney Dis, 2003,42(4 Suppl 3):S1-201.
[10] Lee Y H, Kim J E, Roh Y H, et al. The combination of vitamin D deficiency and mild to moderate chronic kidney disease is associated with low bone mineral density and deteriorated femoral microarchitecture: results from the KNHANES 2008-2011[J]. J Clin Endocrinol Metab, 2014,99(10):3879-3888.
[11] Holick M F. Vitamin D deficiency[J]. N Engl J Med, 2007,357(3):266-281.
[12] Cunningham J, Zehnder D. New vitamin D analogs and changing therapeutic paradigms[J]. Kidney Int, 2011,79(7):702-707.
[13] Carrero J J, Stenvinkel P. Inflammation in end-stage renal disease--what have we learned in 10 years?[J]. Semin Dial, 2010,23(5):498-509.
[14] Kara A V, Soylu Y E. The relationship between vitamin D and inflammatory markers in maintenance hemodialysis patients[J]. Int Urol Nephrol, 2019,51(9):1659-1665.
[15] Villafuerte-Ledesma H M, Moragrega B, Castillon E, et al. Association between vitamin D serum levels and inflammatory markers in patients on hemodialysis[J]. Gac Med Mex, 2020,156(6):509-515.
[16] 罗亚维, 冯胜, 沈华英,等. C反应蛋白/白蛋白比值是腹膜透析患者死亡的独立影响因素[J]. 中华肾脏病杂志, 2022,38(6):528-535.
[17] Sant'Ana M, Gameiro J, Costa C, et al. C-reactive protein-to-albumin ratio and six-month mortality in incident hemodialysis patients[J]. Ren Fail, 2023,45(1):2182615.
[18] Tsoumani M E, Kalantzi K I, Goudevenos I A, et al. Platelet-mediated inflammation in cardiovascular disease. Potential role of platelet-endothelium interactions[J]. Curr Vasc Pharmacol, 2012,10(5):539-549.
[19] Li H, Lu X, Xiong R, et al. High Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients[J]. Mediators Inflamm, 2017,2017:9327136.
[20] Liu S, Yang M, Zhao Q, et al. Platelet-to-Lymphocyte Ratio is Associated with the Mortality in Peritoneal Dialysis Patients[J]. Iran J Kidney Dis, 2021,15(3):206-212.
[21] Muto R, Kato S, Lindholm B, et al. Increased Monocyte/Lymphocyte Ratio as Risk Marker for Cardiovascular Events and Infectious Disease Hospitalization in Dialysis Patients[J]. Blood Purif, 2022,51(9):747-755.
[22] Muresan A V, Russu E, Arbanasi E M, et al. The Predictive Value of NLR, MLR, and PLR in the Outcome of End-Stage Kidney Disease Patients[J]. Biomedicines, 2022,10(6).
[23] Xiang F, Chen R, Cao X, et al. Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study[J]. Hemodial Int, 2018,22(1):82-92.
[24] Kanbay M, Solak Y, Unal H U, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease[J]. Int Urol Nephrol, 2014,46(8):1619-1625.
[25] Chen J, Zhong Z, Shi D, et al. Association between monocyte count to high-density lipoprotein cholesterol ratio and mortality in patients undergoing peritoneal dialysis[J]. Nutr Metab Cardiovasc Dis, 2021,31(7):2081-2088.
[26] Akbas E M, Gungor A, Ozcicek A, et al. Vitamin D and inflammation: evaluation with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio[J]. Arch Med Sci, 2016,12(4):721-727.
[27] Zhao X, Deng C, Li Z, et al. Monocyte/High-Density Lipoprotein Cholesterol Ratio Predicts Vitamin D Deficiency in Male Patients with Type 2 Diabetes Mellitus[J]. Diabetes Metab Syndr Obes, 2022,15:2455-2466.
[28] De Matteis C, Crudele L, Cariello M, et al. Monocyte-to-HDL Ratio (MHR) Predicts Vitamin D Deficiency in Healthy and Metabolic Women: A Cross-Sectional Study in 1048 Subjects[J]. Nutrients, 2022,14(2).
