Prevalence of 25(OH) vitamin D insufficiency and deficiency in chronic kidney disease stage 5 patients on hemodialysis

Abstract

Little is known about the magnitude of vitamin D deficiency in patients with stage 5 chronic kidney disease (CKD-5) on hemodialysis (HD). In the present study, we examined the prevalence of vitamin D deficiency in patients with CKD-5 undergoing HD, evaluating the relationship between calcidiol levels with other parameters of mineral metabolism, nutrition/inflammation, functional capacity (FC), and sunlight exposure. Serum 25(OH) vitamin D levels were evaluated in 84 stable patients on chronic HD not receiving vitamin D supplements, with a mean age 58.9+/-16.6 years, during the month of September (end of winter in the southern hemisphere). 25(OH) vitamin D serum levels, intact PTH (iPTH), as well as serum albumin, calcium, phosphorus, and alkaline phosphatase were analyzed in fasting samples. Similarly, protein catabolic rate (PCR) and body mass index (BMI) were determined as nutritional parameters. Functional capacity according to the Karnofsky index, and sunlight exposure were also analyzed. In this study, we considered adequate vitamin D levels those above 30 ng/mL (U.S.A. National Kidney Foundation DOQI Guidelines), vitamin D insufficiency when levels were between 15 and 30 ng/mL, and vitamin D deficiency when levels were below 15 ng/mL. The mean 25(OH) D levels were significantly higher in men than in women (28.6 vs. 18.9 ng/mL; p=0.001). Vitamin D insufficiency was found in 53.5% of the patients (n=45) and vitamin D deficiency in 22.6% (n=19). In the univariate analysis, there were no correlations between 25(OH) D levels with age, iPTH, calcium, or phosphorus. There were positive correlations between serum 25(OH) D levels and degrees of sunlight exposure (R=0.55; p<0.0001), serum creatinine (r=0.38; p<0.001), serum albumin (r=0.22; p=0.04), and a negative correlation with BMI (r=-0.26; p=0.01). In the multiple regression analysis, only sunlight exposure (B=0.361), BMI (B=-0.23), and gender (B=-0.27) were significantly associated with 25(OH) D levels. Patients with FC 1 to FC 2 (n: 70%, 83.3%) had significantly higher 25(OH) D serum levels compared with FC 3 to FC 4 patients (n: 14%, 16.6%): 25.9 vs. 17.1 ng/mL (p=0.03). These results indicate that vitamin D insufficiency/deficiency is highly prevalent (76.1%) at the end of winter, in stage 5 CKD patients on HD, and lower values seem to be related to decreased sunlight exposure, female gender, increased BMI, and worse functional class.

Bone mineral density and bone metabolism biochemical markers in patients with chronic kidney disease at the hemodialysis treatment

“…This finding suggests the possibility of a significant number of hemodialysis patients with osteomalacia in our study. We found significantly lower levels of 25hD in diabetics females than in non-diabetics and males, which is in agreement with results of other studies (16)(17)(18).…”

Effects of Inactive Vitamin D on Persistent Secondary Hyperparathyroidism in Patients on Hemodialysis

“…Elisa Del Valle reported a prevalence of only 22.6% among patients on HD (18) and Guillermo suggested that 50% of patients with end-stage renal disease (ESRD) had low level of 25(OH)D (19).…”

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

“…Patients with CKD on dialysis (CKD-5D) frequently have low 25(OH)D levels, varying from ,10 ng/ml (25 nmol/L) in 65% of patients in one study (2), to levels ,15 ng/ml (37.5 nmol/L) in 14%-23% of patients in other studies (3,4). Patients on dialysis lack normal renal conversion of 25(OH)D to 1,25-dihydroxyvitamin D [1,25(OH) 2 D], and evidence to support the benefits of increasing 25(OH)D levels with calciferol (cholecalciferol or ergocalciferol) is weak.…”