ORIGINAL ARTICLE: Association between 25‐hydroxyvitamin D, somatic muscle weakness and falls risk in end‐stage renal failure

Abstract

Suboptimal levels of 25OHD in CKD-5D are associated with reduced quadriceps muscle strength and increased falls risk. 25OHD may be more important than the active renal metabolite 1,25(OH)(2)D for muscle strength with implications for vitamin D choice and goals of supplementation. Further investigation is required to examine effectiveness of calciferol supplementation on the incidence of falls in CKD-5D.

Effects of Cholecalciferol on Functional, Biochemical, Vascular, and Quality of Life Outcomes in Hemodialysis Patients

“…However, contrasting results have been reported with high-dose therapy (37). In CKD-5D, lower 25(OH)D levels have been associated with quadriceps weakness and falls risk (18). In this study, baseline 25(OH)D levels correlated to the distance covered in a 6-minute walk test, but not to muscle strength, and no changes were detected over the study duration.…”

“…Some of these actions may be mediated by local conversion of 25(OH)D to 1,25(OH) 2 D at target sites, including muscles, blood vessels and parathyroid glands (14,15). This could explain associations described in CKD-5D, between 25(OH)D levels and pulse wave velocity (PWV), a surrogate for vascular calcification (16), bone mineral density (17), early mortality on dialysis (6), muscle strength, falls risk, and quality of life (18,19).…”

Avaliação da capacidade da Escala Internacional de Eficácia de Quedas em discriminar risco de quedas em pacientes com doença renal crônica submetidos à hemodiálise

“…The prolonged secretion of PTH results in the development of deep cavities between bone trabeculae 23 , causes loss of bone mass, and elevates fracture risks 24 , in addition to prompting an increase in the intracellular concentration of free calcium in muscle tissues 25,26 . Although a study by Boudville et al 20 , and this study did not find association between PTH levels and falling, some researchers observed that higher PTH levels are related to the latter 27,28 , considering that bone fragility, muscle weakness, and poor postural balance are independent risk factors for the occurrence of falls and fractures 29 . Therefore, high PTH levels associated with low vitamin D levels in individuals on hemodialysis cause a negative impact on muscle strength and functional mobility, because they cause the atrophy of muscle fibers of rapid concentration, thus predisposing the individuals to falling 11 .…”

“…With regard to the association between the risk of falling and the PTH levels, only the use of the FES-I in the study conducted by Boudville et al 20 , was found. The researchers did not observe correlation between PTH serum levels and the FES-I, but they reported a higher tendency to fall among the patients who presented low calcitriol serum levels 20 .…”

“…The researchers did not observe correlation between PTH serum levels and the FES-I, but they reported a higher tendency to fall among the patients who presented low calcitriol serum levels 20 . Exactly as it happened in our study, the non-association probably occurred because the PTH is not a direct measurement of bone tissue loss.…”