In patients receiving hemodialysis, a conjugate vaccine can confer partial immunity against S. aureus bacteremia for approximately 40 weeks, after which protection wanes as antibody levels decrease.

Vitamin D has been suggested to have an effect on erythropoiesis. We sought to evaluate the prevalence of anemia in a population of individuals with vitamin D deficiency compared with those with normal levels in a population of a large integrated healthplan. A cross-sectional analysis in the period 1 January 2004 through 31 December 2006 of subjects with documented concurrent levels of 25-hydroxyvitamin D and hemoglobin were evaluated. Vitamin D deficiency was defined as <30 ng/mL and anemia was defined as a hemoglobin <11 g/dL. A total of 554 subjects were included in the analysis. Anemia was present in 49% of 25-hydroxyvitamin D-deficient subjects compared with 36% with normal 25-hydroxyvitamin D levels (p < 0.01). Odds ratio for anemia in subjects with 25-hydroxyvitamin D deficiency using logistic regressions and controlling for age, gender, and chronic kidney disease was 1.9 (95% CI 1.3–2.7). 25-hydroxyvitamin D-deficient subjects had a lower mean Hb (11.0 vs. 11.7; p = 0.12 ) and a higher prevalence of erythrocyte stimulating agent use (47% vs. 24%; p < 0.05). This study demonstrates an association of vitamin D deficiency and a greater risk of anemia, lower mean hemoglobin, and higher usage of erythrocyte-stimulating agents. Future randomized studies are warranted to examine whether vitamin D directly affects erythropoiesis.

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Vitamin D deficiency is associated with a multitude of clinical consequences, including cardiovascular disease (1, 2), decreased bone mineralization (3-5) and early mortality (6). Treatment of 25-hydroxyvitamin D (25-D) deficiency has been associated with positive outcomes including a reduction in falls and improvements in muscle function in elderly individuals (7), reduced risk of hip and nonvertebral fractures (8) and decreased insulin resistance (9). Prospective clinical trials of 25-D supplementation in patients with end-stage renal disease (ESRD) are currently lacking, and the impact of 25-D on clinical outcomes such as bone histomorphology is less clear. Several studies have demonstrated that most hemodialysis (10) and peritoneal dialysis patients are deficient in 25-D (11) and that levels frequently normalize with aggressive supplementation using either ergocalciferol (ERGO) or cholecalciferol (12, 13). The impact of 25-D supplementation on outcomes such as secondary hyperparathyroidism in hemodialysis patients appears to be nominal (14), theoretically because dialysis patients lack the capacity to convert 25-D to 1,25-OH 2 vitamin D (calcitriol), but possibly because the adequate dose for supplementation has yet to be established. While correction of 25-D deficiency appears to have a limited impact on renal osteodystrophy in patients with ESRD, it may improve other clinical outcomes, such as anemia in renal disease. A recent safety and efficacy study of ergocalciferol in hemodialysis patients found a significant reduction in use of recombinant human erythropoietin (EPO) in treated patients (15), with 64% of patients experiencing a reduction in EPO dose after ergocalciferol supplementation. Correction of anemia with EPO has dramatically improved anemia management in hemodialysis patients (16), but

Vitamin D deficiency has been linked to cardiovascular disease and risk factors including hypertension. The authors sought to determine prevalence rates of hypertension in adults tested for 25-hydroxyvitamin D categorized by their levels and evaluate odds ratios for hypertension at lower 25-hydroxyvitamin D levels compared with optimal levels. A cross-sectional study was conducted January 1, 2004, through December 31, 2006, of patients aged 18 years and older within a large ethnically diverse population. Diagnosis of hypertension was determined by International Statistical Classification of Diseases and Related Health Problems codes. Patients were categorized into quartiles according to 25-hydroxyvitamin D levels: ideal (40 ng ⁄ mL), adequate (30-39 ng ⁄ mL), deficient (15-29 ng ⁄ mL), and severely deficient (<15 ng ⁄ mL). Prevalence rates of hypertension and odds ratios were calculated for each 25-hydroxyvitamin D quartile, adjusting for age, sex, race, and renal insufficiency. A total of 2722 individuals met the inclusion criteria for the study. The overall prevalence of hypertension in the study population was 24%. Hypertension rates were 52%, 41%, 27%, and 20% in 25-hydroxyvitamin D quartiles <15 ng ⁄ mL, 15 to 29 ng ⁄ mL, 30 to 39 ng ⁄ mL, and 40 ng ⁄ mL, respectively (P<.001). Odds ratios (95% confidence intervals) for hypertension adjusting for age, sex, race, and renal insufficiency were 2.7 (1.4-5.2), 2.0 (1.5-2.6), and 1.3 (1.2-1.6) for 25-hydroxyvitamin D levels <15 ng ⁄ mL, 15 to 29 ng ⁄ mL, and 30 to 39 ng ⁄ mL, respectively, compared with the 40 ng ⁄ mL group. This study demonstrates increased rates of hypertension in individuals who tested for lower levels of 25-hydroxyvitamin D starting at levels <40 ng ⁄ mL. This retrospective analysis raises the question of whether supplementing to optimal vitamin D levels can prevent or improve hypertension.

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Use of prescription diuretics and incidence of renal cell cancer have increased in the United States in the past 25 years. Recent interview-based epidemiologic studies have reported an association between diuretic use and renal cell cancer risk. Our study evaluated this hypothesis using, for the first time, medical records as the source of the information on prescription diuretic use. Using medical records of women from a prepaid health plan, we identified 191 cases and 191 controls matched on age, membership duration, and membership at diagnosis. Diuretics use and history of potential confounding factors were ascertained by a standardized review of the medical records of each subject, without reference to case or control status. There was a strong and statistically significant association between renal cell cancer and prescription diuretics (odds ratio [OR] adjusted for hypertension, smoking, and obesity = 2.9, 95 percent confidence interval [CI] = 1.7-4.7). Risk tended to increase with dose, measured by number of prescriptions. Since renal cancer can induce hypertension, which is treated by diuretics, and thereby confound the association with diuretics, we examined diuretic use 10 or more years prior to diagnosis when secondary hypertension would be unlikely. The OR for prescriptions 10 or more years before diagnosis was 3.5 (CI = 1.7-7.4). Our results support earlier reports of an excess risk of renal cell cancer among users of prescription diuretics and indicate need for further study to evaluate this relationship, especially due to the extensive use of diuretics and the increasing incidence of this cancer.