慢性肾脏病患者血清维生素水平的变化及意义

目的 探讨不同分期慢性肾脏病(CKD)患者血清维生素水平的变化特点及其相关因素。方法 纳入2021年5月—2022年3月于我院肾病内科就诊的173例CKD患者，包括非透析CKD1-3期组59例、CKD4-5期组79例及血液透析组35例，比较各组患者临床指标的差异，分析14种维生素水平变化特点及与临床指标间的相关性。结果 88%的患者血清维生素B2、B3、B5、B6(吡哆醇)、B9、B12、25(OH)D2、25(OH)D3、E浓度均在正常参考值范围内。随着肾功能恶化，未透析患者维生素A浓度逐渐升高(P<0.05),且透析患者高于非透析患者(P<0.05)。94%的患者存在维生素B1的不足，且透析患者维生素B1浓度低于非透析患者(P<0.05),CKD4-5期组维生素B1水平低于CKD1-3期组(P<0.05)。所有非透析患者均存在25(OH)D的不足或缺乏，但CKD1-3期和CKD4-5期之间无明显差异，透析患者25(OH)D水平高于非透析患者(P<0.05)。相关性分析显示维生素A、B2、B3、B5、B7、B12、25(OH)D、E水平与eGFR均存在弱...

Changes and significance of serum vitamin levels in patients with chronic kidney disease

Objective To explore the characteristics of serum vitamin levels and its related factors in patients with chronic kidney disease (CKD) at different stages. Methods There were 173 CKD patients admitted to the nephrology department of our hospital from May 2021 to March 2022, which included 59 patients in non-dialysis CKD stages 1-3, 79 patients in CKD stages 4-5, and 35 patients in hemodialysis. The differences of clinical indexes of patients in each group were compared, and the level change characteristics of 14 vitamins and their correlation with clinical indicators were analyzed. Results Most of the patients (88%) had serum concentrations of vitamins B2, B3, B5, B6 (pyridoxine), B9, B12, 25 (OH) D2, 25 (OH) D3, and E within the normal reference range. As renal function progressed, vitamin A concentrations gradually increased in non-dialysis patients (P<0.05), but vitamin A concentrations remained higher in dialysis patients than in non-dialysis patients. Vitamin B1 deficiency was found in 94% of participants. The concentration of vitamin B1 in dialysis patients was lower than non-dialysis patients (P<0.05), and the level of vitamin B1 in the CKD stages 4-5 group was lower than the CKD stages 1-3 group (P<0.05). Lack of 25 (OH) D was present in all non-dialysis patients. However, there was no significant difference between the CKD stages 1-3 and the CKD stages 4-5, while dialysis patients had a higher 25 (OH) D than non-dialysis patients (P<0.05). Correlation analysis showed a weak correlation between vitamin A, B2, B3, B5, B7, B12, 25 (OH) D, and E levels and eGFR. It also revealed that vitamin E, B5 and 25 (OH) D were closely related to blood lipid metabolism. Conclusion Most patients with CKD will have various vitamin metabolic abnormalities along with the progression of the disease, mainly including the accumulation of vitamin A and the deficiency of vitamin B1 and 25 (OH) D, which means early monitoring of vitamin levels and timely and reasonable vitamin replacement therapy are necessary.