Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 445 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

ORIGINAL ARTICLE Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 2  |  Page : 215-219
The Influence of Serum 25-hydroxy Vitamin D Levels on Helicobacter Pylori Infections in Patients with End-Stage Renal Failure on Regular Hemodialysis


1 Hemodialysis Section, Hajar Medical, Educational and Therapeutic Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
2 Department of Biochemistry, Center of Research and Reference Laboratory of Iran, Hospital Bu Ali, Damavand St., Tehran, Iran

Click here for correspondence address and email
 

   Abstract 

This study was designed to determine whether the serum levels of 25-OH vitamin D influence the occurrence of infection with Helicobacter Pylori (H.Pylori) in patients on maintenance hemodialysis (HD). The study subjects were patients with end-stage renal disease who were undergoing maintenance dialysis at the hemodialysis section, Hajar Medical, Educational and Therapeutic Center, Shahrekord, Iran. The serum 25-OH vitamin D level and serum H. Pylori specific IgG antibody titers were measured using an enzyme-linked immunosorbent assay (ELISA) method. A total of 36 patients were studied including 21 males and 15 females. The mean age of the study group was 47 (± 17) years. The mean level of serum 25-OH vitamin D was 0.5 ± 18.7 nmol/L (median: 3.5) while the mean value of serum H.Pylori specific IgG antibody titer was 7.7 (±9.9) u/ml (median: 2 u/ml). Thus, a significant positive correlation was found between the levels of serum 25-OH vitamin D and serum H. Pylori specific IgG antibody titers (data adjusted for age, urea reduction rate, duration and dose of dialysis) ( r=0.36, p=0.043). Our study suggests that vitamin D may positively affect the chronic inflammatory status of dialysis patients and may potentiate the immune response in such patients. Because of this immuno-modulatory effect, vitamin D analogs may offer new means to control the inflammatory status in patients on maintenance dialysis.

How to cite this article:
Nasri H, Baradaran A. The Influence of Serum 25-hydroxy Vitamin D Levels on Helicobacter Pylori Infections in Patients with End-Stage Renal Failure on Regular Hemodialysis. Saudi J Kidney Dis Transpl 2007;18:215-9

How to cite this URL:
Nasri H, Baradaran A. The Influence of Serum 25-hydroxy Vitamin D Levels on Helicobacter Pylori Infections in Patients with End-Stage Renal Failure on Regular Hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2020 Sep 25];18:215-9. Available from: http://www.sjkdt.org/text.asp?2007/18/2/215/32312

   Introduction Top


Helicobacter pylori (H. pylori) was culti­vated first from human gastric mucosa in 1983 [1] and, since then, has emerged as one of the most common chronic bacterial infections in the world, affecting about 40 and 80% of the general population in developed and deve­loping countries, respectively.[2] H. pylori has been shown to play an important role in the development of gastritis and gastric ulcer.[3],[4] Dyspeptic symptoms and chronic gastritis are commonly seen in patients with chronic renal failure [5] and infection with H. pylori has also been described in patients on dialysis. [6] However, it is yet unclear whether the occurrence of H. Pylori infection in dialysis patients is due to altered gastric acidity, hyper secretion of gastrin, or increased colonization of the organism.[7],[8] Numerous reports are available on the factors that influence H. Pylori infection in patients on hemodialysis (HD). In an earlier report, we had shown the influence of serum magnesium and secondary hyper parathyroidism on H. Pylori infection in HD patients.[9],[10]

25-hydroxy vitamin D (25-OH Vit D) is the major circulating metabolite of vitamin D.[11] Although the biologically active form of vita­min D is 1,25 (OH)2 vitamin D, synthesized in the kidney, it is widely accepted that the measurement of circulating 25-OH Vit D provides better information with respect to the patients vitamin D status and is used for the diagnosis of hypovitaminosis. [11],[12],[13] In general, the presence of the vitamin D receptor (VDR) indicates that cells are responsive to vitamin D. Apart from osteoblasts, enterocytes and distal renal tubular cells, the VDR is found in many other cell types, such as parathyroid gland cells, skin keratinocytes, colon cells, pituitary gland cells and ovarian cells. The VDR is also widely expressed in most cell types of the immune system, i.e., T cells, B cells, monocytes, macrophages, dendritic cells and NK cells. [14],[15],[16],[17] It has been reported that high blood urea nitrogen levels may correlate with a low prevalence of H. Pylori infection, and that patients on HD may be protected against this infection because of immune deficiency.[18],[19]

This study was designed to determine whether the blood levels of 25-OH vitamin D influence infection with H. Pylori in patients on maintenance HD.


   Patients and Methods Top


Patients

This cross-sectional study was conducted on patients with end-stage renal disease (ESRD), who were on maintenance HD; dialysis was performed using acetate bath dialysate and polysulfone membrane dialyzers in all patients. According to the severity of secondary hyper­parathyroidism, each patient was given oral active vitamin D 3 (Rocaltrol), calcium carbo­nate, and Rena-Gel capsules at various doses. According to the severity of anemia, patients were given intravenous iron sucrose at appro­priate doses after each dialysis session. All patients received, in addition, 6 mg folic acid, 500 mg L - Carnitine and oral vitamin B­complex daily, and also 2000 units of intra­venous recombinant human erythropoietin (rHuEPO), given after each dialysis session.

The exclusion criteria for patients were the usage of drugs that affect gastric acid secretion and/or antibiotics as well as the presence of active or chronic infection before the study. The study was carried out at the HD section of Hajar Medical Educational and Therapeutic Center of Shahrekord University of Medical Sciences in Shahrekord, Iran.

Laboratory methods

The levels of serum 25-OH vitamin D (normal range is 25 to 125 nmol/L) and serum H. Pylori specific IgG antibody titers (titer >10 U/ml was interpreted as positive according to the manufacturer's instructions) were measured as follows: blood samples were drawn after an overnight fast, and were centrifuged within 15 minutes of drawing. The levels were measured by an enzyme-linked immunosorbent assay (ELISA) method using standard kits. Also, peripheral venous blood samples were collected for biochemical analysis including pre and post-dialysis blood urea nitrogen (BUN) and serum albumin (Alb) levels using standard kits after an overnight fast.

Body mass index (BMI) was calculated using the standard formula (post-dialysis weight in kilograms/height in square meters). An assessment of the efficacy of dialysis was made by calculating the urea reduction rate (URR). The duration of each session and the number of sessions of dialysis each patient had received were obtained from the patients' records.

Statistical analysis

The results are expressed as the mean ± SD and median values. A statistical correlation was assessed using a partial correlation test. All statistical analyses were performed using SPSS (version 11.5.00). The statistical significance was determined at a p-value < 0.05.


   Results Top


The total number of patients involved in the study was 36 (Males = 21; Females = 15). Table one summarizes the patients' data. The mean age of the patients was 47 (± 17) years. The mean value of serum 25-OH vitamin D of the study patients was 10.5 ± 18.7 nmol/L (median: 3.5). The mean value of serum H.Pylori specific IgG antibody titer of the study group was 7.7 (± 9.9) u/ml (median: 2 u/ml). The correlation between the serum 25-OH vitamin D level and serum H.Pylori specific IgG antibody titer was statistically significant (data adjusted for age, URR, duration and doses of dialysis) ( r=0.36 p=0.043; [Figure - 1]).


   Discussion Top


The recognition that various cell types carry the VDR has led to a wide array of studies on specific vitamin D functions unrelated to mineral metabolism. The exact mechanism by which the activated form of vitamin D, 1,25­(OH)2D3, affects the immune system has not been elucidated, but it is clear that the immuno­modulating properties are mediated at least in part by the VDR.[20],[21],[22] As mentioned above, the VDR is present in most cell types of the immune system, such as macrophages, den­dritic cells and CD4 + and CD8 + T cells. [19],[20],[21] In these cell types, VDR ligands, such as vitamin D analogs, inhibit the expression of certain cytokines, namely, interleukin (IL)-2 in T cell lines, IL-12 in myelomonocytes, and IL-2, tumor necrosis factor (TNF)-α , interferon (IFN)-γ and GM-CSF in polymorphonuclear cells. [22],[23],[24] Indeed, 1,25-(OH) 2 D 3 inhibits T lymphocyte proliferation and increases dendritic cell maturation and survival. [25],[26] In general, 1,25-(OH) 2 D 3 appears to primarily inhibit Th1- while at the same time favoring Th2-cell differentiation.[27] Activation of the VDR has been shown to inhibit IL-12 production in freshly isolated human mono­cytes or peripheral blood mononuclear cells primed with IFN-γ and stimulated with LPS in a dose-dependent manner. In addition, 1,25­(OH)2D3 was shown to dose dependently inhibit antigen-induced T cell proliferation and production of cytokines, such as IL-2, IL-12 and IFN-γ. [27],[28],[29] Finally, treatment of dendritic cells in vitro with 1,25-(OH)2D3 down-regu­lates the expression of co-stimulatory mole­cules CD40, CD80 and CD86 and decreases the production of IL-12 while, on the other hand, it enhances the expression of the anti­inflammatory cytokine IL-10. [29]

These findings suggest that vitamin D analogs may indeed positively affect the chronic inflammatory status of dialysis patients. In an earlier report, we had shown the inverse correlation between H. Pylori IgG antibody levels and the dose of HD. Addi­tionally, inverse correlation between H. Pylori IgG antibody levels and the serum albumin and dialysis efficacy as well as positive corre­lation with the duration of HD treatment, were also reported in our study, [18] which indicate an inverse association of H. Pylori infection with malnutrition and the resultant immuno-deficiency of HD patients. [18],[30],[31]

In the present study, we found a significant positive correlation between serum 25-OH vitamin D levels and H. Pylori infection. Thus, it appears that vitamin D may indeed posi­tively affect the chronic inflammatory status of dialysis patients and may potentiate the immune response in HD patients. Because of their immuno-modulating effects, vitamin D analogs may offer new means to control the inflammatory status in ESRD patients.

 
   References Top

1.Warren JR, Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1983; I:1273-5.  Back to cited text no. 1    
2.Blaser MJ. Helicobacter pylori: its role in disease. Clin Infect Dis 1992; 15:386-91.  Back to cited text no. 2  [PUBMED]  
3.Nakajima F, Sakaguchi M, Oka H, et al. Prevalence of Helicobacter pylori antibodies in long-term dialysis patients Nephrology 2004;9(2):73-6.  Back to cited text no. 3    
4.Baradaran A. Nasri H. Correlation of serum leptin with circulating anti-helico bacter pylori IgG antibodies in end-stage renal failure patients on regular hemodialysis. Pak J of Nutr 2005;4(6): 389-92.  Back to cited text no. 4    
5.Zwolinska D, Magier K, Miler M, Szprynger K, Szczepanska M, Makulska I.Prevalence of Helicobacter pylori-specific IGG and IGA in children and adolescents with chronic renal failure. Pol Merkur Lek arski 2000;8(46):272-3.  Back to cited text no. 5    
6.Aguilera A, Codoceo R, Bajo MA, et al. Helicobacter pylori infection: a new cause of anorexia in peritoneal dialysis patients. Perit Dial Int 2001;21 Suppl 3:S152-6.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Kim DH, Jung HY, Yang SK, Hong WS, Min YI.Prevalence of Helicobacter pylori in Patients with End Stage Renal Disease. Korean J Gastrointest Endosc 2000; 20(2):97-102.  Back to cited text no. 7    
8.Nardone G, Rocco A, Fiorillo M, et al. Gastroduodenal lesions and Helicobacter pylori infection in dyspeptic patients with and without chronic renal failure. Helicobacter 2005;10(1):53-8.  Back to cited text no. 8    
9.Nasri H, Baradaran A. Relationship of helicobacter pylori specific IgG antibodies with serum magnesium in patients on maintenance hemodialysis. The Journal of Applied Research;2005; (5):438-443.  Back to cited text no. 9    
10.Baradaran A, Nasri H. Helicobacter pylori IgG antibodies in association with secondary hyperparathyroidism in end-stage renal failure patients undergoing regular hemodialysis. Arch Med Sci 2005; 3:148-51.  Back to cited text no. 10    
11.Nasri H, Baradaran A. The association of 25­hydroxyvitamin D levels with secondary hyperparathyroidism in end-stage renal failure patients undergoing regular hemodialysis. Arch Med Sci 2005;4: 236-40.  Back to cited text no. 11    
12.Hollis BW. Assessment of vitamin D nutritional and hormonal status: what to measure and how to do it. Calcif Tissue Int 1996; 58: 4-5.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Thomas MK. Hypovitaminosis D in medical inpatients. N Engl J Med 1998; 338: 777-83.  Back to cited text no. 13    
14.Provvedini DM, Tsoukas CD, Deftos LJ, Manolagas SC. 1,25-dihydroxyvitamin D3 receptors in human leukocytes. Science 1983; 221: 1181-3.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Brennan A, Katz DR, Nunn JD, et al. Dendritic cells from human tissues express receptors for the immunoregulatory vitamin D3 metabolite, dihydroxy cholecalciferol. Immunology 1987; 61: 457-61.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Veldman CM, Cantorna MT, DeLuca HF. Expression of 1,25-dihydroxyvitamin D(3) receptor in the immune system. Arch Biochem Biophys 2000; 374: 334-8.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]
17.Casteels K, Bouillon R, Waer M, Mathieu C. Immunomodulatory effects of 1,25­dihydroxyvitamin D3. Curr Opin Nephrol Hypertension 1995; 4: 313-8.  Back to cited text no. 17    
18.Baradaran A, Nasri H. Helicobacter pylori IgG specific antibodies in association with serum albumin in maintenance hemodialysis patients. Pak J of Nutr 2005; 4 (4): 265-9.  Back to cited text no. 18    
19.Tsukada K, Miyazaki T, Katoh H, et al. Helicobacter pylori infection in hemodialysis patients. Hepatogastroenterology 2003; 50(54):2255-8.  Back to cited text no. 19    
20.Deluca HF, Cantorna MT. Vitamin D: its role and uses in immunology. FASEB J 2001; 15: 2579-85.  Back to cited text no. 20  [PUBMED]  [FULLTEXT]
21.Haussler MR, Whitfield GK, Haussler CA, et al. The nuclear vitamin D receptor: biological and molecular regulatory properties revealed. J Bone Miner Res 1998; 13: 325-49.  Back to cited text no. 21  [PUBMED]  
22.Muller K, Bendtzen K. 1,25-Dihydroxy-vitamin D3 as a natural regulator of human immune functions. J Invest Dermatol Symp Proc 1996; 1: 68-71.  Back to cited text no. 22    
23.D'Ambrosio D, Cippitelli M, Cocciolo MG, et al. Inhibition of IL-12 production by 1,25­dihydroxyvitamin D3. J Clin Invest. 1998; 101: 252-62.  Back to cited text no. 23    
24.Tobler A, Gasson J, Reichel H, Norman AW, Koeffler HP. Granulocyte-macrophage colony­stimulating factor. Sensitive and receptor­mediated regulation by 1,25-dihydroxyvitamin D3 in normal human peripheral blood lymphocytes. J Clin Invest 1987; 79: 1700-5.  Back to cited text no. 24    
25.Matsui T, Takahashi R, Nakao Y, et al. 1,25­dihydroxyvitamin D3-regulated expression of genes involved in human T-lymphocyte proliferation and differentiation. Cancer Res 1986; 46: 5827-31.  Back to cited text no. 25  [PUBMED]  [FULLTEXT]
26.Townsend MJ, Fallon PG, Matthews DJ, Jolin HE, McKenzie AN. T1/ST2-deficient mice demonstrate the importance of T1/ST2 in developing primary T helper cell type 2 responses. J Exp Med. 2000; 191: 1069-76.  Back to cited text no. 26    
27.Rigby WF, Denome S, Fanger MW. Regula-tion of lymphokine production and human T lymphocyte activation by 1,25-dihydroxy-vitamin D3. Specific inhibition at the level of messenger RNA. J Clin Invest 1987; 79: 1659-64.  Back to cited text no. 27    
28.Bhalla AK, Amento EP, Serog B, Glimcher LH. 1,25-Dihydroxyvitamin D3 inhibits antigen-induced T cell activation. J Immunol 1984; 133: 1748-54.  Back to cited text no. 28  [PUBMED]  [FULLTEXT]
29.Piemonti L, Monti P, Sironi M, et al. Vitamin D3 affects differentiation, maturation, and function of human monocyte-derived dendritic cells. J Immunol 2000; 164: 4443-51.  Back to cited text no. 29  [PUBMED]  [FULLTEXT]
30.Nasri H, Baradaran A. Secondary hyper­parathyroidism in association with malnutrition - inflammation complex syndrome in chronic hemodialysis. Ann King Edward Med Coll 2005;11(3):301-6.  Back to cited text no. 30    
31.Nasri H. Serum C-reactive protein (CRP) in association with various nutritional parameters in maintenance hemodialysis patients. Bratisl Lek Listy 2005;106(12):390-5.  Back to cited text no. 31    

Top
Correspondence Address:
Hamid Nasri
Hajar Medical, Educational and Therapeutic Center, Shahrekord University of Medical Sciences, Shahrekord
Iran
Login to access the Email id


PMID: 17496397

Rights and Permissions


    Figures

  [Figure - 1]
 
 
    Tables

  [Table - 1]

This article has been cited by
1 Age and dialysis adequacy in maintenance hemodialysis patients [Hemodiliz hastalari yönetiminde yaş ve dializ yeterliliǧi]
Nasri, H. and Ghaed-Amini, F.
Journal of Clinical and Analytical Medicine. 2013; 4(6)
[Pubmed]
2 Helicobacter pylori infection and serum homocysteine in hemodialysis patient
Rafiean-Kopaei, M. and Baradaran, A. and Maghsoudi, A.-R. and Ghobadi, S. and Nasri, H.
Life Science Journal. 2012; 9(4): 3696-3702
[Pubmed]
3 Association of secondary hyperparathyroidism with malnutrition and inflammation in maintenance hemodialysis patients
Rafiean-Kopaei, M. and Baradaran, A. and Nasri, H.
Life Science Journal. 2012; 9(3): 1871-1878
[Pubmed]
4 Association of body mass index and serum vitamin D level in healthy Iranian adolescents
Baradaran, A. and Behradmanesh, S. and Nasri, H.
Endokrynologia Polska. 2012; 63(1): 29-33
[Pubmed]
5 Ecological studies of the UVB-vitamin D-cancer hypothesis
Grant, W.B.
Anticancer Research. 2012; 32(1 PART 2): 223-236
[Pubmed]
6 Vitamin D, calcium and dairy intake, and risk of oesophageal adenocarcinoma and its precursor conditions
Mulholland, H.G. and Murray, L.J. and Anderson, L.A. and Cantwell, M.M.
British Journal of Nutrition. 2011; 106(5): 732-741
[Pubmed]
7 A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency
Schwalfenberg, G.K.
Molecular Nutrition and Food Research. 2011; 55(1): 96-108
[Pubmed]
8 Healthcare costs of Staphylococcus aureus and Clostridium difficile infections in Veterans: Role of vitamin D deficiency
Youssef, D. and Bailey, B. and El Abbassi, A. and Copeland, R. and Adebonojo, L. and Manning, T. and Peiris, A.N.
Epidemiology and Infection. 2010; 138(9): 1322-1327
[Pubmed]
9 Extragastric manifestations of Helicobacter pylori infection: Other Helicobacters
Moyaert, H. and Franceschi, F. and Roccarina, D. and Ducatelle, R. and Haesebrouck, F. and Gasbarrini, A.
Helicobacter. 2008; 13(SUPPL.1): 47-57
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    References
    Article Figures
    Article Tables
 

 Article Access Statistics
    Viewed7109    
    Printed96    
    Emailed0    
    PDF Downloaded750    
    Comments [Add]    
    Cited by others 9    

Recommend this journal