Chronobiological Changes in Biochemical Hemorrheological Parameters and Cytokine Levels in the Blood of Diabetic Patients on Hemodialysis: A Cross-Sectional Study

Abstract

Introduction: Diabetes mellitus, a chronic disease characterized by hyperglycemia, is a significant contributor to chronic kidney disease, particularly in patients with diabetic nephropathy undergoing renal replacement therapy. Variations in circadian rhythms can influence the progression of chronic diseases and treatment outcomes. Aims: This observational study evaluated gender-based chronobiological changes in biochemical, hemorheological factors, and cytokines in patients with dialysis-dependent diabetic nephropathy. Materials and Methods: A cross-sectional study was conducted in Barra do Garças, Brazil, involving 46 patients with type 2 diabetes mellitus who were on regular hemodialysis. Participants were divided into four groups for analysis according to gender and period of day. Inclusion criteria included individuals with type 2 diabetes mellitus undergoing periodic hemodialysis, receiving hemodialysis care at the service, and signing a consent form. Patients with an age under 18 years, diabetes mellitus type 1, or with autoimmune diseases were excluded. Blood samples were collected to assess melatonin, cortisol, biochemical and hemorheological parameters, and cytokines such as IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, and IL-17. Results: Men exhibited higher melatonin, urea, and creatinine levels in the morning and afternoon phases. At the same time, women showed lower melatonin, increased viscosity, and a decreased deformation rate in the afternoon. Additionally, levels of TNF-α, IFN-γ, and IL-17 were lower in morning serum samples from women. Conclusion: These findings suggest that both gender and circadian timing should be taken into account, when optimizing hemodialysis treatment for patients with diabetic nephropathy. A deeper understanding of these factors could lead to more personalized and effective treatment strategies, ultimately improving patient outcomes and enhancing their quality of life.

Keywords

• diabetes mellitus
• diabetic nephropathy
• cytokines
• chronic renal disease
• rheology