Physiological Associations between Vitamin B Deficiency and Diabetic Kidney Disease

Abstract

The number of people living with chronic kidney disease (CKD) is growing as our global population continues to expand. With aging, diabetes, and cardiovascular disease being major harbingers of kidney disease, the number of people diagnosed with diabetic kidney disease (DKD) has grown concurrently. Poor clinical outcomes in DKD could be influenced by an array of factors—inadequate glycemic control, obesity, metabolic acidosis, anemia, cellular senescence, infection and inflammation, cognitive impairment, reduced physical exercise threshold, and, importantly, malnutrition contributing to protein-energy wasting, sarcopenia, and frailty. Amongst the various causes of malnutrition in DKD, the metabolic mechanisms of vitamin B (B1 (Thiamine), B2 (Riboflavin), B3 (Niacin/Nicotinamide), B5 (Pantothenic Acid), B6 (Pyridoxine), B8 (Biotin), B9 (Folate), and B12 (Cobalamin)) deficiency and its clinical impact has garnered greater scientific interest over the past decade. There remains extensive debate on the biochemical intricacies of vitamin B metabolic pathways and how their deficiencies may affect the development of CKD, diabetes, and subsequently DKD, and vice-versa. Our article provides a review of updated evidence on the biochemical and physiological properties of the vitamin B sub-forms in normal states, and how vitamin B deficiency and defects in their metabolic pathways may influence CKD/DKD pathophysiology, and in reverse how CKD/DKD progression may affect vitamin B metabolism. We hope our article increases awareness of vitamin B deficiency in DKD and the complex physiological associations that exist between vitamin B deficiency, diabetes, and CKD. Further research efforts are needed going forward to address the knowledge gaps on this topic.

Anemia of Chronic Kidney Disease—A Narrative Review of Its Pathophysiology, Diagnosis, and Management

“…Water-soluble vitamin B12 also called cobalamin plays an important role in maintaining homeostasis, cellular metabolism, antioxidation, and red blood cell synthesis [ 33 , 34 ]. It is supplied to the body mainly with food like liver, meat, seafood, or milk [ 33 , 34 , 35 ]. CKD is often accompanied by diabetes that may impair the absorption of this vitamin, whereas a demand for vitamin B12 may be increased [ 35 ].…”

“…It is supplied to the body mainly with food like liver, meat, seafood, or milk [ 33 , 34 , 35 ]. CKD is often accompanied by diabetes that may impair the absorption of this vitamin, whereas a demand for vitamin B12 may be increased [ 35 ]. In most of these patients, additional supplementation may be necessary [ 33 ].…”

“…Currently, there is no evidence of a direct relationship between cobalamin deficiency and CKD, but the influence of hyperhomocysteinemia induced by cobalamin deficiency might affect the progression of CKD [ 34 , 35 ]. In CKD, cobalamin metabolites are indicators of functional status, but most patients with CKD have vitamin B12 levels within the normal range [ 34 , 35 ]. Vitamin B12 supplementation is also recommended for patients receiving folic acid [ 33 , 34 ].…”

“…Hyperhomocysteinemia supports reactive oxygen and nitrogen radicle formation, which reduces the bioavailability of nitric oxide. As a result, collagen accumulates, which affects vascular remodeling and progressive changes in the vascular system, which causes damage to the microcirculation in the glomeruli and may also cause glomerular sclerosis and acute kidney damage [ 34 , 35 , 37 ]. As a consequence, greater degree of proliferation of vascular smooth muscle cells subsequently leading to hardening of are associated with podocyte function disruption that increases progression of renal fibrosis [ 35 ].…”

Mantidisflavin A: A Riboflavin Derivative Featuring a 6/6/6/5/5 Skeleton from the Egg Cases of the Insect Tenodera sinensis Saussure and Its Anti-Renal Fibrosis Activity

“…A deficiency in riboflavin is associated with significant abnormalities, including kidney failure, growth retardation, anemia, skin lesions, and neurodegenerative changes. − The study conducted by Alam et al. also highlighted histopathological improvements in the kidneys of diabetic mice after riboflavin supplementation .…”