diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12958diaendo-12958Research ArticleОригинальные исследованияOriginal StudiesСтруктура минеральных и костных нарушений у пациентов с хронической болезнью почек 5 диализной стадии с учетом наличия или отсутствия сахарного диабета 1 типаThe structure of mineral and bone disorders in patients with сhronic kidney disease of the 5th dialysis stage, taking into account the presence or absence of a diagnosis of type 1 diabetes mellitushttps://orcid.org/0000-0002-0067-3622МаганеваИ. С.MaganevaI. S.

Маганева Ирина Сергеевна, врач-эндокринолог

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117036, Москва, ул. Дмитрия Ульянова, д. 11

Irina S. Maganeva, MD

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maganeva.ira@yandex.ruhttps://orcid.org/0000-0001-6667-062XЕремкинаА. К.EremkinaA. K.

Еремкина Анна Константиновна, к.м.н., ведущий научный сотрудник

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Anna K. Eremkina, MD, PhD, leading research asscociate

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a.lipatenkova@gmail.comhttps://orcid.org/0000-0002-9462-8522МилютинаА. П.MiliutinaA. P.

Милютина Анастасия Павловна

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Anastasiia P. Miliutina, MD

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oa11111998@gmail.comhttps://orcid.org/0000-0003-2257-3224МартыновС. А.MartynovS. A.

Мартынов Сергей Андреевич, д.м.н.

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Sergey A. Martynov, MD, PhD

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smartynov@inbox.ruhttps://orcid.org/0000-0002-0296-4933СеверинаА. С.SeverinaA. S.

Северина Анастасия Сергеевна, к.м.н., ведущий научный сотрудник

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Anastasia S. Severina, MD, PhD, leading research associate

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ansev1@mail.ruhttps://orcid.org/0000-0001-8694-9679СалимхановР. Х.SalimkhanovR. H.

Салимханов Рустам Халилович

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Rustam Kh. Salimkhanov

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rustam.salimkhanov@gmail.comhttps://orcid.org/0000-0001-6009-9872ЕвлоеваМ. И.EvloevaM. I.

Евлоева Мадина Иссаевна

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Madina I. Yevloyeva

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madevis_6@mail.ruhttps://orcid.org/0000-0002-3433-0142ШамхаловаМ. Ш.ShamkhalovaM. Sh.

Шамхалова Минара Шамхаловна, д.м.н.

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Minara S. Shamhalova, MD, PhD

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shamkhalova@mail.ruhttps://orcid.org/0000-0002-5057-127XШестаковаМ. В.ShestakovaM. V.

Шестакова Марина Владимировна, д.м.н., профессор, академик РАН

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Marina V. Shestakova MD, PhD, Professor

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nephro@endocrincentr.ruhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна, д.м.н., профессор, член-корреспондент РАН

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Natalia G. Mokrysheva, MD, PhD, Professor

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parathyroid.enc@gmail.comНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian FederationНациональный медицинский исследовательский центр эндокринологии; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияEndocrinology Research Centre; Pirogov Russian National Research Medical UniversityRussian Federation202228122022256512522Copyright © Маганева И.С., Еремкина А.К., Милютина А.П., Мартынов С.А., Северина А.С., Салимханов Р.Х., Евлоева М.И., Шамхалова М.Ш., Шестакова М.В., Мокрышева Н.Г., 20232023Маганева И.С., Еремкина А.К., Милютина А.П., Мартынов С.А., Северина А.С., Салимханов Р.Х., Евлоева М.И., Шамхалова М.Ш., Шестакова М.В., Мокрышева Н.Г.Maganeva I.S., Eremkina A.K., Miliutina A.P., Martynov S.A., Severina A.S., Salimkhanov R.H., Evloeva M.I., Shamkhalova M.S., Shestakova M.V., Mokrysheva N.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12958ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. У пациентов с терминальной стадией хронической болезни почек (тХБП), получающих заместительную почечную терапию программным гемодиализом (ЗПТ ПГД), тяжесть осложнений связана с метаболическими нарушениями: накоплением уремических токсинов, нефрогенной анемией, вторичным гиперпаратиреозом, внекостной кальцификацией, нарушением клиренса и ритма секреции гормонов.

ЦЕЛЬ

ЦЕЛЬ. Оценить основные биохимические и гормональные показатели, а также структуру минеральных и костных нарушений у пациентов, получающих ЗПТ ПГД, до и после гемодиализа (ГД) с учетом наличия или отсутствия сахарного диабета (СД).

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. В исследование вошли 40 пациентов с тХБП, находящихся на ЗПТ ПГД: 1-я группа — 24 пациента с СД 1 типа (СД1); 2-я — 16 пациентов без СД. Статистический анализ проведен в программных пакетах Statistica v.13 (StatSoft, США) и SPSS (IBM, США). Критический уровень статистической значимости при проверке гипотез принят равным 0,05.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Уровень интактного паратгормона (иПТГ) до и после ГД был ниже в группе 1 (р<0,001). Уровень щелочной фосфатазы был значимо выше в группе 2 (р=0,012). В обеих группах до ГД была выявлена высокая частота гипокальциемии (по альбумин-скорректированному кальцию в 1-й группе — в 58,3%, во 2-й группе — в 43,7% случаев, р=0,366) и гиперфосфатемии (в 66,7 и в 43,7% случаев соответственно, р=0,151). Гипокальциемия после ГД в 1-й группе сохранялась в 14%, во 2-й группе — в 20% случаев (р>0,05); гиперфосфатемия в 1-й группе полностью нивелировалась, во 2-й группе сохранялась в 7% случаев (р=0,417). До сеанса ГД в группе 1 были значимо выше уровни эндогенного рецептора к конечному продукту гликирования (RAGE) , глюкагона, иммунореактивного инсулина (ИРИ), кортизола и глюкозы, чем после сеанса ГД (р<0,05). Во 2-й группе после ГД значимо снизились уровни глюкагона, ИРИ и кортизола (р<0,05), а уровень 3-нитротирозина значимо увеличился (р=0,026). В 1-й группе фиброкальциноз клапанов сердца по данным Эхо-КГ и кальцификация артерий нижних конечностей по данным ультразвуковой допплерографии встречались чаще, чем во 2-й группе (42% vs 25%, p<0,001 и 75% vs 37,5%, р=0,018 соответственно (χ2)). Компрессионные переломы встречались с одинаковой частотой в обеих группах (60%). Снижение минеральной плотности костной ткани до уровня остеопении отмечалось чаще в группе 1 (50% vs 18,8%), а остеопороз встречался чаще в группе 2 (68,8% vs 33,3%) (p<0,001, χ2).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Пациенты с СД1 имели повышенный риск почечной остеодистрофии с низким обменом костной ткани из-за ряда метаболических факторов, присущих СД. Низкий уровень ПТГ в группе 1 может отражать влияние СД на фосфорно-кальциевый обмен. В то же время динамика показателей фосфора и кальция во время процедуры ГД была аналогичной.

BACKGROUND

BACKGROUND: In patients with end-stage CKD, receiving renal replacement therapy (RRT) with programmed hemodialysis (HD), the severity of complications is associated with metabolic disturbances: accumulation of uremic toxins, nephrogenic anemia, secondary hyperparathyroidism (SHPT), extraskeletal calcification, impaired clearance and rhythm of hormone secretion.

AIM

AIM: To evaluate the main biochemical and hormonal parameters, and manifestations of mineral bone disease (MBD) in patients receiving RRT with HD, before and after hemodialysis, taking into account the presence or absence of diabetes mellitus.

MATERIALS AND METHODS

MATERIALS AND METHODS: We divided all patients receiving RRT with HD in two groups: #1 (n=24) — patients with DM, #2 (n=16) — patients without DM. All of them had their blood analyzed before and immediately after the HD. Data analysis was performed with the Statistica 13 (StatSoft, USA). A prognostically significant model was considered at p<0.05.

RESULTS

RESULTS: The level of iPTH, both at baseline and after HD, was lower in group #1 (p<0.001). The level of alkaline phosphatase (AP) was significantly higher in group #2 (p=0.012). In both groups before HD, a high incidence of hypocalcemia was detected (according to albumin-corrected calcium in group #1 in 58.3%, in group #2 in 43.7% of cases, p = 0.366) and hyperphosphatemia (in 66.7% and in 43 .7% of cases, respectively, p=0.151). Hypocalcemia after HD in group #1 persisted in 14%, in group #2 — in 20% of cases (p>0.05); hyperphosphatemia in group #1 was completely leveled, in group #2 it persisted in 7% of cases (p=0.417). Prior to the HD session, group #1 had significantly higher levels of RAGE, glucagon, immunoreactive insulin (IRI), cortisol, and glucose than after the HD session (p<0.05). In group #2, after HD, the levels of glucagon, IRI and cortisol significantly decreased (p<0.05), and the level of 3-nitrotyrosine (3-HT) increased significantly (p=0.026). In group #1, fibrocalcinosis of the heart valves according to ECHO and calcification of the arteries of the lower extremities according to ultrasonic doplerography were more common than in group #2 (42% vs 25%, p<0.001 and 75% vs 37.5%, p=0.018, respectively). (χ2)). Compression fractures occurred with the same frequency in both groups (60%). A decrease in bone mineral density (BMD) to the level of osteopenia was noted more often in group #1 (50% vs 18.8%), and osteoporosis was more common in group #2 (68.8% vs 33.3%) (p<0.001, χ2).

CONCLUSION

CONCLUSION: The low level of PTH in group #1 may reflect the effect of diabetes on calcium-phosphorus metabolism. Patients with DM have an increased risk of renal osteodystrophy with a low bone turnover because of a number of metabolic factors inherent in diabetes. At the same time, the dynamics of phosphorus and calcium indicators during the HD procedure were similar.

минеральные и костные нарушениягиперпаратиреозсахарный диабетгемодиализостеопорозвнескелетная кальцификацияmineral and bone disordershyperparathyroidismdiabetes mellitushemodialysisosteoporosisextraskeletal calcificationРабота проведена в рамках выполнения Государственного задания Минздрава России (АААА-А20-120011790181-1).ReferencesBikbov B, Purcell CA, Levey AS, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733. doi: https://doi.org/10.1016/S0140-6736(20)30045-3Bikbov B, Purcell CA, Levey AS, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733. doi: https://doi.org/10.1016/S0140-6736(20)30045-3Johansen KL, Chertow GM, Foley RN, Wetmore JB. US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2021;77(4S1):A7-A8. doi: https://doi.org/10.1053/j.ajkd.2021.01.002Johansen KL, Chertow GM, Foley RN, Wetmore JB. US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2021;77(4S1):A7-A8. doi: https://doi.org/10.1053/j.ajkd.2021.01.002Jorgensen MB, Idorn T, Knop FK, et al. Clearance of glucoregulatory peptide hormones during haemodialysis and haemodiafiltration in non-diabetic end-stage renal disease patients. Nephrol Dial Transplant. 2015;30(3):513-520. doi: https://doi.org/10.1093/NDT/GFU327Jorgensen MB, Idorn T, Knop FK, et al. Clearance of glucoregulatory peptide hormones during haemodialysis and haemodiafiltration in non-diabetic end-stage renal disease patients. Nephrol Dial Transplant. 2015;30(3):513-520. doi: https://doi.org/10.1093/NDT/GFU327Duranton F, Cohen G, De Smet R, et al. Normal and pathologic concentrations of uremic toxins. J Am Soc Nephrol. 2012;23(7):1258-1270. doi: https://doi.org/10.1681/ASN.2011121175Duranton F, Cohen G, De Smet R, et al. Normal and pathologic concentrations of uremic toxins. J Am Soc Nephrol. 2012;23(7):1258-1270. doi: https://doi.org/10.1681/ASN.2011121175Shinohara K, Shoji T, Emoto M, et al. Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol. 2002;13(7):1894-1900. doi: https://doi.org/10.1097/01.ASN.0000019900.87535.43Shinohara K, Shoji T, Emoto M, et al. Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol. 2002;13(7):1894-1900. doi: https://doi.org/10.1097/01.ASN.0000019900.87535.43Assiri A, Kamel HFM, ALrefai A. Critical Appraisal of Advanced Glycation End Products (AGEs) and Circulating Soluble Receptors for Advanced Glycation End Products (sRAGE) as a Predictive Biomarkers for Cardiovascular Disease in Hemodialysis Patients. Med Sci (Basel, Switzerland). 2018;6(2):38. doi: https://doi.org/10.3390/MEDSCI6020038Assiri A, Kamel HFM, ALrefai A. Critical Appraisal of Advanced Glycation End Products (AGEs) and Circulating Soluble Receptors for Advanced Glycation End Products (sRAGE) as a Predictive Biomarkers for Cardiovascular Disease in Hemodialysis Patients. Med Sci (Basel, Switzerland). 2018;6(2):38. doi: https://doi.org/10.3390/MEDSCI6020038Byon CH, Chen Y. Molecular Mechanisms of Vascular Calcification in Chronic Kidney Disease: The Link between Bone and the Vasculature. Curr Osteoporos Rep. 2015;13(4):206. doi: https://doi.org/10.1007/S11914-015-0270-3Byon CH, Chen Y. Molecular Mechanisms of Vascular Calcification in Chronic Kidney Disease: The Link between Bone and the Vasculature. Curr Osteoporos Rep. 2015;13(4):206. doi: https://doi.org/10.1007/S11914-015-0270-3Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol. 2015;11(5):302-313. doi: https://doi.org/10.1038/NRNEPH.2015.38Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol. 2015;11(5):302-313. doi: https://doi.org/10.1038/NRNEPH.2015.38Nakao T, Inaba M, Abe M, et al. Best Practice for Diabetic Patients on Hemodialysis 2012. Ther Apher Dial. 2015;19(S1):40-66. doi: https://doi.org/10.1111/1744-9987.12299Nakao T, Inaba M, Abe M, et al. Best Practice for Diabetic Patients on Hemodialysis 2012. Ther Apher Dial. 2015;19(S1):40-66. doi: https://doi.org/10.1111/1744-9987.12299Soleymanian T, Kokabeh Z, Ramaghi R, et al. Clinical outcomes and quality of life in hemodialysis diabetic patients versus non-diabetics. J Nephropathol. 2017;6(2):81. doi: https://doi.org/10.15171/JNP.2017.14Soleymanian T, Kokabeh Z, Ramaghi R, et al. Clinical outcomes and quality of life in hemodialysis diabetic patients versus non-diabetics. J Nephropathol. 2017;6(2):81. doi: https://doi.org/10.15171/JNP.2017.14Ceriello A, Ihnat MA, Thorpe JE. The “Metabolic Memory”: Is More Than Just Tight Glucose Control Necessary to Prevent Diabetic Complications? J Clin Endocrinol Metab. 2009;94(2):410-415. doi: https://doi.org/10.1210/JC.2008-1824Ceriello A, Ihnat MA, Thorpe JE. The “Metabolic Memory”: Is More Than Just Tight Glucose Control Necessary to Prevent Diabetic Complications? J Clin Endocrinol Metab. 2009;94(2):410-415. doi: https://doi.org/10.1210/JC.2008-1824Górriz JL, Molina P, Cerverón MJ, et al. Vascular calcification in patients with nondialysis CKD over 3 years. Clin J Am Soc Nephrol. 2015;10(4):654-666. doi: https://doi.org/10.2215/CJN.07450714Górriz JL, Molina P, Cerverón MJ, et al. Vascular calcification in patients with nondialysis CKD over 3 years. Clin J Am Soc Nephrol. 2015;10(4):654-666. doi: https://doi.org/10.2215/CJN.07450714Мокрышева Н.Г., Егшатян Л.В. Минерально-костный обмен при хронической болезни почек. Монография. — М.: МИА; 2020.Mokrysheva NG, Egshatjan LV. Mineral’no-kostnyj obmen pri hronicheskoj bolezni pochek. Monografija. Moscow: MIA; 2020. (In Russ.).Рожинская Л.Я., Егшатян Л.В. Патология костной системы при вторичном гиперпаратиреозе у пациентов с терминальной стадией хронической болезни почек на заместительной почечной терапии (гемодиализ) (обзор литературы) // Остеопороз и остеопатии. — 2010. — Т. 13. — №2. — С. 18-22. doi: https://doi.org/10.14341/osteo2010218-22Rozhinskaya LY, Egshatyan LV. Patologiya kostnoy sistemy pri vtorichnom giperparatireoze u patsientov s terminal’noystadiey khronicheskoy bolezni pochek na zamestitel’noypochechnoy terapii (gemodializ) (obzor literatury). Osteoporosis and Bone Diseases. 2010;13(2):18-22. (In Russ.). doi: https://doi.org/10.14341/osteo2010218-22Rodriguez-Garcia M, Naves M, Cannata-Andнa J. Bone metabolism, vascular calcifications and mortality: associations beyond mere coincidence. J Nephrol. 2005;18:458-463.Rodriguez-Garcia M, Naves M, Cannata-Andнa J. Bone metabolism, vascular calcifications and mortality: associations beyond mere coincidence. J Nephrol. 2005;18:458-463.Miller PD. Treatment of osteoporosis in chronic kidney disease and end-stage renal disease. Curr Osteoporos Rep. 2005;3(1):5-12. doi: https://doi.org/10.1007/s11914-005-0021-y.Miller PD. Treatment of osteoporosis in chronic kidney disease and end-stage renal disease. Curr Osteoporos Rep. 2005;3(1):5-12. doi: https://doi.org/10.1007/s11914-005-0021-y.Готье С.В., Хомяков С.М. Донорство и трансплантация органов в Российской Федерации в 2019 году. XII сообщение регистра Российского трансплантологического общества // Вестник трансплантологии и искусственных органов. — 2020. — Т. 22. — №2. — С. 8-34. doi: https://doi.org/10.15825/1995-1191-2020-2-8-34Готье С.В., Хомяков С.М. Донорство и трансплантация органов в Российской Федерации в 2019 году. XII сообщение регистра Российского трансплантологического общества // Вестник трансплантологии и искусственных органов. — 2020. — Т. 22. — №2. — С. 8-34. doi: https://doi.org/10.15825/1995-1191-2020-2-8-34Thornalley PJ, Battah S, Ahmed N, et al. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7(1):1-59. doi: https://doi.org/10.1016/j.kisu.2017.04.001Thornalley PJ, Battah S, Ahmed N, et al. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7(1):1-59. doi: https://doi.org/10.1016/j.kisu.2017.04.001Thornalley PJ, Battah S, Ahmed N, et al. Quantitative screening of advanced glycation endproducts in cellular and extracellular proteins by tandem mass spectrometry. Biochem J. 2003;375(3):581-592. doi: https://doi.org/10.1042/bj20030763Thornalley PJ, Battah S, Ahmed N, et al. Quantitative screening of advanced glycation endproducts in cellular and extracellular proteins by tandem mass spectrometry. Biochem J. 2003;375(3):581-592. doi: https://doi.org/10.1042/bj20030763Бирагова М.С., Глазунова А.М., Шамхалова М.Ш., и др. Роль нарушений минерального и костного обмена в развитии и прогрессировании кардиальной и почечной патологии у больных с длительным течением сахарного диабета 1-го типа // Проблемы эндокринологии. — 2013. — Т. 59. — №5. — С. 16-24. doi: https://doi.org/10.14341/probl201359516-24Biragova MS, Glazunova AM, Shamkhalova MS, et al. The role of mineral and bone metabolism disorders in the development and progression of cardiac and renal pathology in the patients presenting with long-lasting type 1 diabetes mellitus. Problems of Endocrinology. 2013;59(5):16-24. (In Russ.). doi: https://doi.org/10.14341/probl201359516-24Costantini S, Conte C. Bone health in diabetes and prediabetes. World J Diabetes. 2019;10(8):421-445. doi: https://doi.org/10.4239/WJD.V10.I8.421Costantini S, Conte C. Bone health in diabetes and prediabetes. World J Diabetes. 2019;10(8):421-445. doi: https://doi.org/10.4239/WJD.V10.I8.421Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168(12):1340-1349. doi: https://doi.org/10.1001/archinte.168.12.1340Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168(12):1340-1349. doi: https://doi.org/10.1001/archinte.168.12.1340Inaguma D, Nagaya H, Hara K, et al. Relationship between serum 1,25-dihydroxyvitamin D and mortality in patients with pre-dialysis chronic kidney disease. Clin Exp Nephrol. 2008;12(2):126-131. doi: https://doi.org/10.1007/s10157-007-0023-4Inaguma D, Nagaya H, Hara K, et al. Relationship between serum 1,25-dihydroxyvitamin D and mortality in patients with pre-dialysis chronic kidney disease. Clin Exp Nephrol. 2008;12(2):126-131. doi: https://doi.org/10.1007/s10157-007-0023-4Baker LRI, Abrams SML, Roe CJ, et al. 1,25(OH)2D3 administration in moderate renal failure: A prospective double-blind trial. Kidney Int. 1989;35(2):661-669. doi: https://doi.org/10.1038/ki.1989.36Baker LRI, Abrams SML, Roe CJ, et al. 1,25(OH)2D3 administration in moderate renal failure: A prospective double-blind trial. Kidney Int. 1989;35(2):661-669. doi: https://doi.org/10.1038/ki.1989.36Watson KE, Abrolat ML, Malone LL, et al. Active Serum Vitamin D Levels Are Inversely Correlated With Coronary Calcification. Circulation. 1997;96(6):1755-1760. doi: https://doi.org/10.1161/01.CIR.96.6.1755Watson KE, Abrolat ML, Malone LL, et al. Active Serum Vitamin D Levels Are Inversely Correlated With Coronary Calcification. Circulation. 1997;96(6):1755-1760. doi: https://doi.org/10.1161/01.CIR.96.6.1755Teng M, Wolf M, Ofsthun MN, et al. Activated Injectable Vitamin D and Hemodialysis Survival: A Historical Cohort Study. J Am Soc Nephrol. 2005;16(4):1115-1125. doi: https://doi.org/10.1681/ASN.2004070573Teng M, Wolf M, Ofsthun MN, et al. Activated Injectable Vitamin D and Hemodialysis Survival: A Historical Cohort Study. J Am Soc Nephrol. 2005;16(4):1115-1125. doi: https://doi.org/10.1681/ASN.2004070573Muñoz-Garach A, García-Fontana B, Muñoz-Torres M. Vitamin D status, calcium intake and risk of developing type 2 diabetes: an unresolved issue. Nutrients. 2019;11(3):642. doi: https://doi.org/10.3390/nu11030642Muñoz-Garach A, García-Fontana B, Muñoz-Torres M. Vitamin D status, calcium intake and risk of developing type 2 diabetes: an unresolved issue. Nutrients. 2019;11(3):642. doi: https://doi.org/10.3390/nu11030642Liu C, Lu M, Xia X, et al. Correlation of serum vitamin D level with type 1 diabetes mellitus in children: A meta-analysis. Nutr Hosp. 2015;32(4):1591-1594. doi: https://doi.org/10.3305/nh.2015.32.4.9198Liu C, Lu M, Xia X, et al. Correlation of serum vitamin D level with type 1 diabetes mellitus in children: A meta-analysis. Nutr Hosp. 2015;32(4):1591-1594. doi: https://doi.org/10.3305/nh.2015.32.4.9198Feng R, Li Y, Li G, et al. Lower serum 25 (OH) D concentrations in type 1 diabetes: A meta-analysis. Diabetes Res Clin Pract. 2015;108(3):e71-75. doi: https://doi.org/10.1016/j.diabres.2014.12.008Feng R, Li Y, Li G, et al. Lower serum 25 (OH) D concentrations in type 1 diabetes: A meta-analysis. Diabetes Res Clin Pract. 2015;108(3):e71-75. doi: https://doi.org/10.1016/j.diabres.2014.12.008Shen L, Zhuang Q-S, Ji H-F. Assessment of vitamin D levels in type 1 and type 2 diabetes patients: Results from metaanalysis. Mol Nutr Food Res. 2016;60(5):1059-1067. doi: https://doi.org/10.1002/mnfr.201500937Shen L, Zhuang Q-S, Ji H-F. Assessment of vitamin D levels in type 1 and type 2 diabetes patients: Results from metaanalysis. Mol Nutr Food Res. 2016;60(5):1059-1067. doi: https://doi.org/10.1002/mnfr.201500937Поваляева А.А., Пигарова Е.А., Дзеранова Л.К., Рожинская Л.Я. Взаимосвязь статуса витамина D с развитием и течением сахарного диабета 1 типа // Ожирение и метаболизм. — 2020. — Т. 17. — №1. — С. 82-87. doi: https://doi.org/10.14341/omet12206Povaliaeva AA, Pigarova EA, Dzeranova LK, Rozhinskaya LY. The relationship of vitamin D status with the development and course of diabetes mellitus type 1. Obesity and metabolism. 2020;17(1):82-87. (In Russ.). doi: https://doi.org/10.14341/omet12206Colette C, Pares-Herbute N, Monnier L, et al. Effect of different insulin administration modalities on vitamin D metabolism of insulin-dependent diabetic patients. Horm Metab Res. 1989;21(1):37-41. doi: https://doi.org/10.1055/s-2007-1009144Colette C, Pares-Herbute N, Monnier L, et al. Effect of different insulin administration modalities on vitamin D metabolism of insulin-dependent diabetic patients. Horm Metab Res. 1989;21(1):37-41. doi: https://doi.org/10.1055/s-2007-1009144Jørgensen MB, Idorn T, Knop FK, et al. Clearance of glucoregulatory peptide hormones during haemodialysis and haemodiafiltration in non-diabetic end-stage renal disease patients. Nephrol Dial Transplant. 2015;30(3):513-520. doi: https://doi.org/10.1093/NDT/GFU327Jørgensen MB, Idorn T, Knop FK, et al. Clearance of glucoregulatory peptide hormones during haemodialysis and haemodiafiltration in non-diabetic end-stage renal disease patients. Nephrol Dial Transplant. 2015;30(3):513-520. doi: https://doi.org/10.1093/NDT/GFU327Ben-David E, Hull R, Banerjee D. Diabetes mellitus in dialysis and renal transplantation. Ther Adv Endocrinol Metab. 2021;12(3):204201882110486. doi: https://doi.org/10.1177/20420188211048663Ben-David E, Hull R, Banerjee D. Diabetes mellitus in dialysis and renal transplantation. Ther Adv Endocrinol Metab. 2021;12(3):204201882110486. doi: https://doi.org/10.1177/20420188211048663Kalkhoff RK, Siegesmund KA. Fluctuations of calcium, phosphorus, sodium, potassium, and chlorine in single alpha and beta cells during glucose perifusion of rat islets. J Clin Invest. 1981;68(2):517-524. doi: https://doi.org/10.1172/JCI110283Kalkhoff RK, Siegesmund KA. Fluctuations of calcium, phosphorus, sodium, potassium, and chlorine in single alpha and beta cells during glucose perifusion of rat islets. J Clin Invest. 1981;68(2):517-524. doi: https://doi.org/10.1172/JCI110283Leclercq-Meyer V, Marchand J, Malaisse WJ. Calcium dependently of glucagons release: its modulation by nutritional factors. Am J Physiol. 1979;236(2):E98-E104. doi: https://doi.org/10.1152/ajpendoLeclercq-Meyer V, Marchand J, Malaisse WJ. Calcium dependently of glucagons release: its modulation by nutritional factors. Am J Physiol. 1979;236(2):E98-E104. doi: https://doi.org/10.1152/ajpendoБалаболкин М.И., Клебанова Е.М., Креминская В.М. Дифференциальная диагностика и лечение эндокринных заболеваний (руководство). — М.: «Медицина»; 2002. — 751 с.Balabolkin MI, Klebanova EM, Kreminskaja VM. Differencial’naja diagnostika i lechenie jendokrinnyh zabolevanij (rukovodstvo). Moscow: «Medicina»; 2002. — 751 p. (In Russ.).Cheung AK, Sarnak MJ, Yan G, et al. Cardiac diseases in maintenance hemodialysis patients: Results of the HEMO Study. Kidney Int. 2004;65(6):2380-2389. doi: https://doi.org/10.1111/j.1523-1755.2004.00657.xCheung AK, Sarnak MJ, Yan G, et al. Cardiac diseases in maintenance hemodialysis patients: Results of the HEMO Study. Kidney Int. 2004;65(6):2380-2389. doi: https://doi.org/10.1111/j.1523-1755.2004.00657.xAssiri A, Kamel HFM, Alrefai A. Critical appraisal of advanced glycation end products (AGEs) and circulating soluble receptors for advanced glycation end products (sRAGE) as a predictive biomarkers for cardiovascular disease in hemodialysis patients. Med Sci (Basel). 2018;6(2):38. doi: https://doi.org/10.3390/MEDSCI6020038Assiri A, Kamel HFM, Alrefai A. Critical appraisal of advanced glycation end products (AGEs) and circulating soluble receptors for advanced glycation end products (sRAGE) as a predictive biomarkers for cardiovascular disease in hemodialysis patients. Med Sci (Basel). 2018;6(2):38. doi: https://doi.org/10.3390/MEDSCI6020038Tada Y, Yano S, Yamaguchi T, et al. Advanced glycation end products-induced vascular calcification is mediated by oxidative stress: functional roles of NAD(P)H-oxidase. Horm Metab Res. 2013;45(4):267-272. doi: https://doi.org/10.1055/S-0032-1329965Tada Y, Yano S, Yamaguchi T, et al. Advanced glycation end products-induced vascular calcification is mediated by oxidative stress: functional roles of NAD(P)H-oxidase. Horm Metab Res. 2013;45(4):267-272. doi: https://doi.org/10.1055/S-0032-1329965Byon CH, Chen Y. Molecular mechanisms of vascular calcification in chronic kidney disease: The link between bone and the vasculature. Curr Osteoporos Rep. 2015;13(4):206. doi: https://doi.org/10.1007/S11914-015-0270-3Byon CH, Chen Y. Molecular mechanisms of vascular calcification in chronic kidney disease: The link between bone and the vasculature. Curr Osteoporos Rep. 2015;13(4):206. doi: https://doi.org/10.1007/S11914-015-0270-3Asenjo-Bueno A, Alcalde-Estévez E, El Assar M, et al. Hyperphosphatemia-Induced Oxidant/Antioxidant Imbalance Impairs Vascular Relaxation and Induces Inflammation and Fibrosis in Old Mice. Antioxidants. 2021;10(8):1308. doi: https://doi.org/10.3390/antiox10081308Asenjo-Bueno A, Alcalde-Estévez E, El Assar M, et al. Hyperphosphatemia-Induced Oxidant/Antioxidant Imbalance Impairs Vascular Relaxation and Induces Inflammation and Fibrosis in Old Mice. Antioxidants. 2021;10(8):1308. doi: https://doi.org/10.3390/antiox10081308

The authors declare that there are no conflicts of interest present.