Effect of cholecalciferol on immune and vascular func4on in non-diabe4c chronic kidney disease

Kajal Kamboj ¹ Aruna Pariki ² MANPHOOL SINGHAL ² Anupam Lal ² Sachin Naik ¹ Vivek Kumar ¹ Ashok Kumar Yadav ^3* Vivek Jha ⁴

• ¹ Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Haryana, India
• ² Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research,, Chandigarh, India
• ³ Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
• ⁴ George Institute for Global Health, New Delhi, National Capital Territory of Delhi, India

Background and aims: Vitamin D deficiency, widely prevalent in paEents with CKD could play a role in the pathogenesis of CVD by causing alteraEons in endothelial and immune funcEon.We invesEgated the change in immune and vascular funcEons following vitamin D supplementaEon in non-diabeEc subjects with stage 3-4 CKD and vitamin D deficiency.In this single-arm study, non-diabeEc CKD subjects aged 18-75 years, eGFR 15-60 ml/min/1.73m 2 , and serum 25-hydroxyvitamin D3 levels <20 ng/ml were enrolled. Enrolled subjects received directly observed oral dose of 300,000 IU cholecalciferol at baseline and 8weeks. Outcome assessment including immunological, vascular, endothelial, inflammatory and biochemical parameters were measured at baseline and 16 weeks.Results: 62 subjects were studied. Mean age was 44 ± 12 years with 58% males. TH1 cells decreased from 17 (9, 27) % to 11 (6, 16) %, p=0.002 and TH2 cells increased from 9 (5, 16) % to 16 (10, 27) %, p=0.001 aler cholecalciferol treatment. Significant increase in mRNA expression of vitamin D responsive genes (cathelicidin, IL-10, VDR and CYP27B1) was observed. Levels of pro-inflammatory cytokines (IFN-g, TNF-a, IL-23 and IL-6) decreased whereas anE-inflammatory cytokines (IL-4, IL-10 and IL-13) showed an increase.Cholecalciferol treatment improved flow mediated dilataEon (FMD): 8.2 (6.2, 12.1) % at baseline to 14.1 (10.0, 20.1) % at 16 weeks (p<0.001).This study confirms that cholecalciferol supplementaEon influences immune funcEon as it favoured TH2/TH1 phenotype, favourably affected the levels of inflammatory markers and mRNA expression of vitamin D responsive genes and improved vascular function in CKD.