Evaluative Study Of Inflammatory Markers Crp, Homocysteine And Vitamin- B12 In All Stages Of Ckd
Keywords:
Chronic kidney disease, C-reactive protein, Homocysteine and Vitamin-B12Abstract
Introduction: Chronic kidney disease (CKD) is identified by the presence of kidney damage, either structural or functional, or by a decline in glomerular filtration rate (GFR) below 60 mL/min/1.73 m2 of body surface area for more than 3 months.
Aim: To do a comparative study of Homocysteine, CRP and Vitamin B12 in different stages of chronic kidney disease.
Method: All the parameters serum CRP, Vitamin-B12 and Serum Homocysteine were estimated by VITROS 3600 immunodiagnostic system and VITROS 5600 integrated system using intellicheck technology.
Statistical analysis: The collected data was entered into MS excel sheet in proper format and analyzed for p-value, student t-test, mean value and standard deviation with the help of SPSS's latest software (version 29.0) and Microsoft excel. p-value <0.05 was considered as significant.
Result: Serum CRP and Homocysteine levels are lower in CKD stage 1 and statistically significantly higher in CKD stage 5 and Vitamin-B12 level is higher in CKD stage 1 and reduced in CKD stage 5, which is statistically significant.
Conclusion: In the study, statistically high homocysteine and low vitamin B12 levels were observed in different stages of chronic kidney disease. Hyperhomocysteinemia is associated with increase stages of kidney failure mostly in stages 4 and stage 5, therefore supplementation of vitamins should be done in these stages which will correct both Hyperhomocysteinemia and low vitamin-B12.
References
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. vol. 139. 2003.
Johns Hopkins. End Stage Renal Disease (ESRD). Johns Hopkins Medicine 2023.
National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. The Wayback Machine 2002:1–2. https://web.archive.org/web/ 20050415152237/http:/www.kidney.org/professionals/kdoqi/guidelines_ckd/1/2TheWaybackMachine-https://web.archive.org/web/20050415152237/http://www.kidney.org:80/professionals/k….
Hock So B. Chronic Kidney Disease: Determining chronicity, prevalence, variation and survival in a community chronic kidney disease (CKD):cohort study. Cohort Study. College of Medical, Veterinary and Life Sciences University of Glasgow, 2018.
National Kidney Foundation. Clinical Practice Guidelines for Chronic Kidney Disease. 2023.
Levey Andrew S, Coresh Josef. Clinical practice guidelines for chronic kidney disease : evaluation, classification and stratification. 2002.
Long Y, Nie J. Homocysteine in Renal Injury. Kidney Diseases 2016;2:80–7. https://doi.org/10.1159/ 000444900.
Dittrich S, Tadesse BT, Moussy F, Chua A, Zorzet A, Tängdén T, et al. Target product profile for a diagnostic assay to differentiate between bacterial and non-bacterial infections and reduce antimicrobial overuse in resource-limited settings: An expert consensus. PLoS One 2016;11. https://doi.org/10.1371/ journal.pone.0161721.
Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-Reactive Protein, Interleukin 6, and Risk of Developing Type 2 Diabetes Mellitus. Journal of American Medical Association 2001;286:327–34.
Li J, Chen J, Lan HY, Tang Y. Role of C-Reactive Protein in Kidney Diseases. Kidney Diseases 2023;9:73–81. https://doi.org/10.1159/000528693.
Miller A, Korem M, Almog R, Galboiz Y. Vitamin B12, demyelination, remyelination and repair in multiple sclerosis. J Neurol Sci, vol. 233, 2005, p. 93–7. https://doi.org/10.1016/j.jns.2005.03.009.
Greer JP. Wintrobe’s clinical hematology. 13th ed. 2014.
Soni KK, Kalyanasundaram M, Singh S, Shubham S, Sabde YD, Prakash A, et al. Prevalence of chronic kidney disease among severely gas-exposed survivors in Bhopal, India. Natl Med J India 2023;36:5–10. https://doi.org/10.252549/NMJI_569_20.
Lalramenga PC, Gupta S, P N. Study of C-Reactive Protein Significance in Chronic Kidney Disease. International Journal of Contemporary Medical Research [IJCMR] 2019;6. https://doi.org/10.21276/ ijcmr.2019.6.6.48.
Adejumo OA, Okaka EI, Okwuonu CG, Iyawe IO, Odujoko OO. Serum C-reactive protein levels in pre-dialysis chronic kidney disease patientsin southern Nigeria. Ghana Med J 2016;50:31–8. https://doi.org/10.4314/gmj.v50i1.5.
Margus Annuk, Inga Soveri, Mihkel Zilmer, Lars Lind, Johannes Hulthe, Bengt Fellström. Endothelial function, CRP and oxidative stress in chronic kidney disease. J Nephrol 2005;18:721–6.
Varughese S, Abraham G. Chronic kidney disease in India: A clarion call for change. Clinical Journal of the American Society of Nephrology 2018;13:802–4. https://doi.org/10.2215/CJN.09180817.
Levi A, Cohen E, Levi M, Goldberg E, Garty M, Krause I. Elevated serum homocysteine is a predictor of accelerated decline in renal function and chronic kidney disease: A historical prospective study. Eur J Intern Med 2014;25:951–5. https://doi.org/10.1016/j.ejim.2014.10.014.
O Samuelsson, D M Lee, P O Attman, C Knight-Gibson, J K Mullen, R Larsson, et al. The plasma levels of homocysteine are elevated in moderate renal insufficiency but do not predict the rate of progression. Neprology 1999;82:306–11. https://doi.org/10.1159/000045445.
Mark J Sarnak, Shin-Ru Wang, Gerald J Beck, John W Kusek, Jacob Selhub, Tom Greene, et al. Homocysteine, cysteine, and B vitamins as predictors of kidney disease progression. American Journal of Kidney Disease 2002;40:932–9. https://doi.org/10.1053/ajkd.2002.36323.
Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Tanaka K, Okubo K, et al. Hyperhomocysteinemia and the development of chronic kidney disease in a general population: the Hisayama study. vol. 44. 2004.
Remacha Á, Sanz C, Contreras E, De Heredia CD, Grifols JR, Lozano M, et al. Guidelines on haemovigilance of post-transfusional iron overload. Blood Transfusion 2013;11:128–39. https://doi.org/10.2450/2012.0114-11.
Andrea Angelini, Maria Laura Cappuccilli, Giacomo Magnoni, Anna Laura Croci Chiocchini, Valeria Aiello, Angelo Napoletano, et al. The link between homocysteine, folic acid and vitamin B12 in chronic kidney disease. Bologna, Italy: 2020.
McMahon GM, Hwang SJ, Tanner RM, Jacques PF, Selhub J, Muntner P, et al. The association between vitamin B12, albuminuria and reduced kidney function: An observational cohort study. BMC Nephrol 2015;16. https://doi.org/10.1186/1471-2369-16-7.
Anurag A. A Study on the Levels of Folic Acid, Vitamin B12 and Plasma Homocysteine in Patients with Chronic Kidney Disease. vol. 70. 2022.
Yonova D, Dimitrova V, Trendafilov I, Papazov V, Arabadjieva D, Velkova N. Comparative Study of Homocysteine and Vitamin B12 in Patients on Hemodialysis Younger or Older Than 65 Years. International Journal of Family Medicine and Primary Care 2020;1:1–2.
Farrington DK, Sang Y, Grams ME, Ballew SH, Dunning S, Stempniewicz N, et al. Anemia Prevalence, Type, and Associated Risks in a Cohort of 5.0 Million Insured Patients in the United States by Level of Kidney Function. American Journal of Kidney Diseases 2023;81:201-209.e1. https://doi.org/ 10.1053/j.ajkd. 2022.07.014.
Hitesh H. Shah, Steven Fishbane. 37 - Anemia and Its Treatment in Patients With End-Stage Kidney Disease. Handbook of Dialysis Therapy. 6th ed., 2023, p. 341–50. https://doi.org/https://doi.org/10.1016/B978-0-323-79135-9.00037-9.
MATTHEWS DM, BECKETT AG. Serum vitamin B12 in renal failure. J Clin Pathol 1962;15:456–8. https://doi.org/10.1136/jcp.15.5.456.
Wu HHL, Wang AYM. Vitamin B12 and chronic kidney disease. Vitam Horm, vol. 119, Academic Press Inc.; 2022, p. 325–53. https://doi.org/10.1016/bs.vh.2022.01.011.
Pastore A, Noce A, Di Giovamberardino G, De Stefano A, Callà C, Zenobi R, et al. Homocysteine, cysteine, folate and vitamin B12 status in type 2 diabetic patients with chronic kidney disease. J Nephrol 2015;28:571–6. https://doi.org/10.1007/s40620-014-0126-4.