Vitamin D deficiency, CD4+CD28null cells and Accelerated Atherosclerosis in Chronic Kidney Disease
Nephrology,  Clinical Article

Yadav AK et al. - Vitamin D deficiency, inflammatory activation and higher frequency of CD4+CD28null T lymphocyte population correlate with preclinical atherosclerotic changes in chronic kidney disease (CKD) population. These findings suggest possible linkage between vitamin D metabolism and T cell modulation, abnormalities which may contribution to development of atherosclerosis in CKD.

Methods
  • A total of of 101 stage 4-5 non-dialysis CKD patients and 40 healthy controls were studied.
  • Common carotid artery intima media thickness (CCA-IMT) was measured with an ultrasound system.
  • 25(OH) vitamin D and highly sensitive C-reactive protein (hsCRP) were measured in serum by ELISA.

Results
  • The frequency of circulating CD4+CD28null cells was evaluated by flowcytometry.
  • CKD subjects exhibited higher CCA-IMT (0.71±0.01 v 0.56±0.01 mm, p<0.0001), hsCRP (90.7±5.8 v 50.1±8.6 µg/ml, p<0.0001), CD4+CD28null cell frequency (9.1±0.9 v 3.6±0.5%, p<0.0001) and lower 25(OH) vitamin D levels (17.9±1.9 v 26.9±3.5 ng/ml, p<0.0001).
  • In CKD subjects, serum 25 (OH) vitamin D level showed a strong inverse correlation with CCA-IMT (r=-0.729, p<0.0001), and correlated with CD4+CD28null cell frequency (r=-0.249, p=0.01) and hsCRP (r=-0.2, p=0.047).
  • The authors also noted correlation of IMT with patient age (r=0.291, p=0.004) and CD4+CD28null cells (r=0.34, p=0.001).
  • On multiple regression analysis, 25(OH) vitamin D level, diabetic status and CD4+CD28null cell frequency exhibited independent association with IMT in CKD subjects.

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