Serum calcium and phosphorous balance in diabetic nephropathy and its correlation with glycated hemoglobin

Authors

  • Liji Kavuparambil Department of Biochemistry, MES Medical College, Perinthalmanna, Kerala, India http://orcid.org/0000-0001-9016-0419
  • Ashok Kumar P. Department of Biochemistry, Rajah Muthiah Medical College, Annamalai University, Tamil Nadu,
  • Jithesh T. K. Department of Biochemistry, MES Medical College, Perinthalmanna, Kerala, India
  • Shifa Kollathodi Department of Biochemistry, MES Medical College, Perinthalmanna, Kerala, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20214070

Keywords:

Glycated hemoglobins, Glomerular filtration rate, Diabetic nephropathy, Calcium

Abstract

Background: Timely control of hemoglobin A1c (HbA1c) level is very important in patients with diabetic kidney disease. Diabetic nephropathy brings changes in mineral metabolism. The changes in calcium and phosphorous level is a reason for increased morbidity or decreased quality of life in these patients. Conflicting reports are available on serum calcium level and decline in kidney function. This study is to analyse the changes in calcium and phosphorous level in different stages of diabetic nephropathy and its correlation with glycated haemoglobin.

Methods: A cross sectional study with 60 diabetic nephropathy patients admitted in MES Medical College for a period of 1.5 years. Patients with cardiac, liver, thyroid dysfunction, under dialysis were excluded from the study. Fasting blood sugar, HbA1c, calcium, phosphorous, creatinine were assessed by VITROS 5600 integrated system. The study population is divided into groups by two different means, according to HbA1c and estimated glomerular filtration rate (eGFR) value. Statistical analysis was performed by statistical package for the social sciences (SPSS) software. Level of significance calculated at 95%.

Results: eGFR value showed a highly significant correlation with age (p=0.016), creatinine (p≤0.00001), calcium (p≤0.00001), phosphorous (p≤0.00001) and HbA1c (p=0.00001). There was no significant difference in creatinine and eGFR between male and female subjects. Only eGFR (p=0.0396) showed a significant difference between poor and good glycaemic control groups.

Conclusions: This study shows highly significant correlation between the decreased eGFR hypocalcaemia, hyperphosphatemia, increased serum creatinine level and HbA1c. Strict glycemic control is crucial in maintenance of mineral homeostasis and prevention of blood calcium, phosphorous abnormalities.

Author Biographies

Ashok Kumar P., Department of Biochemistry, Rajah Muthiah Medical College, Annamalai University, Tamil Nadu,

VICE-PRINCIPAL & PROFESSOR, DEPARTMENT OF BIOCHEMISTRY

Jithesh T. K., Department of Biochemistry, MES Medical College, Perinthalmanna, Kerala, India

ASSOCIATE PROFESSOR, DEPARTMENT OF BIOCHEMISTRY

Shifa Kollathodi, Department of Biochemistry, MES Medical College, Perinthalmanna, Kerala, India

PROFESSOR & HOD, DEPARTMENT OF BIOCHEMISTRY

References

Zhang XX, Kong J, Yun K. Prevalence of Diabetic Nephropathy among Patients with Type 2 Diabetes Mellitus in China: A Meta-Analysis of Observational Studies. J Diabet Res. 2020;1:1-11.

Varma PP. Prevalence of chronic kidney disease in India - Where are we heading? Indian J Nephrol. 2015;25(3):133-5.

Wu AYT, Kong NCT, de Leon FA, Pan CY, Yeung VTF, Rouillon A, Weir MR. An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: The Micro Albuminuria Prevalence (MAP) study. Diabetologia. 2005;48(1):17-26.

Ting IW, Yeh HC, Huang HC, Chiang HY, Chu PL, Kuo CC. Joint Longitudinal Low Calcium High Phosphorus Trajectory Associates with Accelerated Progression, Acute Coronary Syndrome and Mortality in Chronic Kidney Disease. Nature. 2020;10:9682.

Blaine J, Chonchol M, Levi M. Renal Control of Calcium, Phosphate, and Magnesium Homeostasis. Clin J Am Soc Nephrol. 2015;10:1257-72.

Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K. Definition, evaluation, and classification of renal osteodystrophy: A position statement from kidney disease: Improving global outcomes (KDIGO). Kidney Int. 2006;69:1945 53.

Russo D, Corrao S, Battaglia Y, Andreucci M, Caiazza A, Carlomagno A, et al. Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int. 2011;80:112 8.

Vikrant S, Parasher A. Prevalence and severity of disordered mineral metabolism in patients with chronic kidney disease: A study from a tertiary care hospital in India. Indian J Endocr Metab. 2016;20:460-7.

Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: first report of the Indian CKD registry? BMC Nephrology. 2012;13:10.

Randie R, William LA. Review of Variant Hemoglobins Interfering with Hemoglobin A1c Measurement. J Diabet Sci Tech. 2009;3:446-50.

Hassan ABE, Elsheikh WAR, Rahman NIA, Elbagir NM. Serum Calcium Levels in Correlation with Glycated Hemoglobin in Type 2 Diabetic Sudanese Patients. Adv Diabet Metabol. 2016;4(4):59-64.

Schwarz S, Trivedi BK, Kalantar-Zadeh K, Kovesdy CP. Association of disorders in mineral metabolism with progression of chronic kidney disease. Clin J Am Soc Nephrol. 2006;1:825-31.

Bargman JM, Skorecki K. Chronic kidney disease. In Braunwald E, Fauci AS. Harrison’s Principles of Internal Medicine. 18th edition. New York: Mc Graw Hill International Publication. 2011;2:2308.

Sharma AP, Yasin A. Diagnostic accuracy of creatinine based eGFR Equations at different GFR levels in children. Clin J Am Soc Nephrol. 2011;6:1599-608.

Freethi R, Raj AV, Ponniraivan K, Khan MR, Sundhararajan A, Venkatesan. Study of serum levels of calcium, phosphorus and alkaline phosphatase in chronic kidney disease. Int J Med Res Health Sci. 2016;5(3):49-56.

Sirgrist MK, Taal MW, Bungay P, Mclntyre CW. Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 adn 5 chronic kidney diseases. Clin J Am Soc Nephrol. 2007;1241-8.

Haglin L, Lindblad A, Bygren LO. Hypophosphataemia in the metabolic syndrome. Gender differences in body weight and blood glucose. Eur J Clin Nutr. 2001;55(6):493-8.

Park W, Kim BS, Lee JE, Huh JK, Kim BJ, Sung KC, et al. Serum phosphate levels and the risk of cardiovascular disease and metabolic syndrome; a double-edged sword. Diabetes Res Clin Pract. 2009;83(1):119-25.

Pawar A, Prasad S, Kumar R, Sharma P, Manhas S, Bhutani K, Kumar M. Effects of diabetic nephropathy on phosphorous homeostasis. Int Educ Res J. 2019;5(1):1-9.

Hus AI, Tahleel B, Hasan AEI, Albagir EH, Mohammad MA, Salah S, Elmahdi SA. Serum Calcium Level in Type 2 Diabetes Mellitus in Khartoum State. Clin Microbiol. 2019;8:332.

Dabelea D, Stafford JM, Mayer-Davis EJ, Dolan L, Linder B, et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. JAMA. 2017;317:825-35.

Lupica R, Buemi M, Campenni A, Trimboli D, Canale V, Cernaro V, Santoro D. Unexpected hypercalcemia in a diabetic patient with kidney disease. World J Nephrol. 2015;4(3):438-43.

Janmaat C, Diepen MV, Gasparini A, Evans M, Qureshi AR, Arnlov J, et al. Lower serum calcium is independently associated with CKD progression. Scientific Rep. 2018;8:5148.

Lim LM, Kuo HT, Kuo MC, Chiu YW, Lee JJ, Hwang HJ, Tsai JC, Hung CC, Chen HC. Low serum calcium is associated with poor renal outcomes in chronic kidney disease stages 3-4 patients. BMC Nephrol. 2014;15:183.

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Published

2021-10-26

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Original Research Articles