Chronic Kidney Disease (Ckd)

Abstract

ABSTRACT… Introduction: Vitamin D deficiency is pretty common among the patients with CKD some studies suggesting it to be starting from CKD 3 when the egfr start falling from 60 ml/min. The cause can be due to different reasons including race, obesity, nutrition, lack of exposure to sun, and not the least, decrease in 1,alpha hydroxylase once the gfr starts to fall significantly. Objectives: The hypothesis was that lower Vitamin D level will be associated with increased inflammatory burden and decreased immunological response. Study Design: This was a cross-sectional study looking at the relationship between Vitamin D level and inflammatory markers in CKD 4 Pts when egfr started falling from 30 ml/min. Study Design and Duration: The study was started in March 2016 and finished in May 2016 among consecutive 100 CKD 4 patients coming to the clinic who were identified to be eligible for the study. Materials and Methods: We looked at the relationship between Vitamin D level and markers of mineral bone disorder, similarly we also looked at the relationship between erythropoietin dosage, hemoglobin and Vitamin D levels. Erythropoietin dose, hemoglobin, transferrin saturation, were used to study the link between Vitamin D and markers of anemia. Hepatitis B surface antigen antibodies were measured to study the response between Vitamin D level and immune response to Hep B vaccine. Results: Vitamin D levels were significantly lower in diabetics compared to non-diabetics (P = 0.02) and lower in females compared to males (P = 0.009). No statistical significance was observed between Vitamin D levels and immune response to hepatitis B vaccine (P = 0.89), phosphate level (P= 0.1), calcium levels (P = 0.79), parathyroid hormone (PTH) levels (P = 0.57), C-reactive protein (P =0.19), serum albumin (P = 0.17), hemoglobin level (P = 0.18,) and erythropoietin requirement (P = 0.87).Conclusions Vitamin D deficiency is highly prevalent in advanced CKD in Saudi Arabia. A RCT is recommended regarding response to vitamin D supplementation.