Association between calcitriol and paricalcitol with oxidative stress in patients with hemodialysis
Abstract
Abstract.Background: The pathophysiological basis of chronic kidney disease and its complications, including cardiovascular disease, are associated with chronic inflammation and oxidative stress. We investigated the effects of active vitamin D (calcitriol) and synthetic vitamin D analog (paricalcitol) on oxidative stress in hemodialysis patients. Methods: This cross-sectional study was composed of 83 patients with a minimum hemodialysis vintage of one year. Patients with a history of any infection, malignancy, and chronic inflammatory disease were excluded. Oxidative markers (total oxidant and antioxidant status) and inflammation markers (C-reactive protein and interleukin-6) were analyzed. Results: A total of 47% (39/83) patients were using active or analog vitamin D. Total antioxidant status was significantly higher in patients with using active or analog vitamin D than those who did not use (p = 0.006). Whereas, total oxidant status and oxidative stress index were significantly higher in patients with not using vitamin D when compared with the patients who were using vitamin D preparation (p = 0.005 and p = 0.004, respectively). On the other hand, total antioxidant status, total oxidant status, and oxidative stress index were similar between patients who used active vitamin D or vitamin D analog (p = 0.6; p = 0.4 and p = 0.7, respectively). Conclusion: The use of active or selective vitamin D analog in these patients decreases total oxidant status and increases total antioxidant status. Also, paricalcitol is as effective as calcitriol in decreasing total oxidant status and increasing total antioxidant status in patients with chronic kidney disease.
References
1 . Burden of chronic kidney disease: an international perspective. Adv Chronic Kidney Dis. 2010;17:215–24.
2 . Chronic kidney disease diagnosis and management: a review. Jama. 2019;322:1294–304.
3 . Oxidative stress in chronic kidney disease. Oxid Med Cel Long. 2016;2016:8375.
4 Curcumin ameliorates kidney function and oxidative stress in experimental chronic kidney disease. Basic Clin Pharmacol Toxicol. 2018;122:65–73.
5 . Oxidative stress in kidney transplantation: causes, consequences, and potential treatment. Iran J Kidney Dis. 2011;5:357–72.
6 . Oxidative stress in chronic kidney disease. Iran J Kidney Dis. 2015;9:165.
7 . Oxidative stress – chronic kidney disease – cardiovascular disease: A vicious circle. Life Sci. 2018;1:125–131.
8 . A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem. 2004;37:112–9.
9 . Vitamin D in oxidative stress and diseases. A critical evaluation of vitamin D – Basic Overview. IntechOpen; 2017.
10 . Vitamin D: update 2013: from rickets prophylaxis to general preventive healthcare. Dermatoendocrinol. 2013;5:331–47.
11 . Immunopathogenesis of neurodegenerative diseases: current therapeutic models of neuroprotection with special reference to natural products. Curr Pharm Des. 2012;18:34–42.
12 . Vitamin D deficiency, oxidative stress and antioxidant status: only weak association seen in the absence of advanced age, obesity or pre-existing disease. Br J Nutr. 2017;118:11–6.
13 Evaluation of the serum prooxidant-antioxidant balance before and after vitamin D supplementation in adolescent Iranian girls. Adv Med Sci. 2019;64:174–80.
14 . Vitamin d deficiency: Effects on oxidative stress, epigenetics, gene regulation, and aging. Biology. 2019;8:30.
15 The effect of some medications given to CKD patients on vitamin D levels. Nefrología. 2015;35:150–6.
16 . Comparison of paricalcitol and calcitriol in dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled studies. Ther Apher Dial. 2019;23:73–9.
17 . Antioxidant role of vitamin D in mice with alloxan-induced diabetes. Can J Diabetes. 2018;42:412–8.
18 . Cardiac tissue oxidative stress and inflammation after vitamin D administrations in high fat-diet induced obese rats. BMC Cardiovasc Disord. 2017;17:161.
19 . Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol. 1993;4:1205–13.
20 . The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. New Eng J Med. 1993;329:1001–6.
21 Revisiting interdialytic weight gain and mortality association with serum albumin interactions: The Japanese dialysis outcomes and practice pattern study. J Ren Nutr. 2017;27:421–9.
22 . Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis. 2001;38:85–90.
23 KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013;3:5–14.
24 . Dose conversion from recombinant human erythropoietin to darbepoetin alfa: recommendations from clinical studies. Pharmacotherapy: J Hum Pharmacol. Drug Ther. 2002;22:160S–5S.
25 . A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005;38:1103–11.
26 . A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation. Clin Biochem. 2004;37:277–85.
27 . Effect of exercise on cardiac tissue oxidative and inflammatory mediators in chronic kidney disease. Am J Nephrol. 2009;29:213–21.
28 Vitamin E-coated dialyzer reduces oxidative stress in hemodialysis patients. Free Radic Biol Med. 2001;31:233–41.
29 . Oxidative stress in hemodialysis patients: a review of the literature. Oxid Med Cel Long. 2017;2017.
30 Oxidative stress in cell death and cardiovascular diseases. Oxidative medicine and cellular longevity. 2019;2019.
31 Active form of vitamin D ameliorates non-alcoholic fatty liver disease by alleviating oxidative stress in a high-fat diet rat model. Endocr J. 2017;64:663–73.
32 . Vitamin D Supplementation Reduces Both Oxidative DNA Damage and Insulin Resistance in the Elderly with Metabolic Disorders. Int J Mol Sci. 2019;20:2891.
33 . Vitamin D activates the Nrf2-Keap1 antioxidant pathway and ameliorates nephropathy in diabetic rats. Am J Hypertens. 2013;27:586–95.
34 The role of vitamin d and oxidative stress in chronic kidney disease. Int J Environ Res Public Health. 2018;15:2701.
35 . Vitamin D analogues: how do they differ and what is their clinical role? Nephrol DialTranspl. 2001;16:1965–7.
36 Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients. BMC Nephrol. 2012;13:159.
37 Biological evaluation of new vitamin D2 analogues. J Steroid Biochem Mol Biol. 2016;164:66–71.