Relationship Between Vitamin D and Muscle Size and Strength in Patients on Hemodialysis

Abstract

OBJECTIVE-Vitamin D has various actions in skeletal muscle. The purpose of this study was to compare lower limb muscle size and strength in hemodialysis (HD) patients being treated with 1,25-dihydroxyvitamin D (calcitriol) or a 1,25-dihydroxyvitamin D analog (paricalcitol) to HD patients who were receiving none.DESIGN-This was a retrospective cross-sectional study. SETTING-Outpatient hemodialysis centers.PATIENTS-HD patients receiving calcitriol or paricalcitol (active vitamin D) for control of secondary hyperparathyroidism (VitD, n = 49) were compared to HD patients who were not (n = 30).MAIN OUTCOME MEASURES-Cross-sectional areas (CSA) of thigh and tibialis anterior muscles by magnetic resonance imaging (MRI), and three measures of strength; three-repetition maximum (3RM) for knee extension (isotonic), peak torque of knee extensors (isokinetic), and maximal voluntary contraction (MVC) of the ankle dorsiflexor muscles (isometric).RESULTS-There were no differences in age, weight, dialysis vintage, or intact parathyroid hormone levels between the groups, although serum albumin was higher in the VitD group (p <0.05). Patients in the VitD group had larger thigh muscle CSA (p < 0.05) and were stronger across all strength measures (p< 0.05) after controlling for age and gender (ANCOVA). When all analyses were subsequently adjusted for serum albumin concentration, only the difference in 3RM knee extension strength lost significance. There were no significant differences in any measurements between patients who received calcitriol or paricalcitol.CONCLUSION-Treatment with active vitamin D was associated with greater muscle size and strength in this cohort of HD patients.

Effects of alfacalcidol on circulating cytokines and growth factors in rat skeletal muscle

“…The potential importance of CYP27B1 in muscle wasting has been shown by the muscle atrophy in patients with chronic renal failure, which have sufficient 25D but lack CYP27B1 [54] and thus may suffer from intracellular vitamin D deficiency in the presence of normal circulating 25D levels. These patients did indeed improve muscle size and strength when they were treated with 1,25D [55]. In our study, the CYP27B1 expression in the muscle was not altered despite elevated serum levels of 1,25D (see Fig.…”

Dietary Vitamin D3 Supplementation at 10× the Adequate Intake Improves Functional Capacity in the G93A Transgenic Mouse Model of ALS, a Pilot Study

“…Supplementing 800 IU D 3 /d in double-blind, randomized, placebo-controlled trials (RCTs) reduces the risk of falls in the elderly by 27-72% [34][35][36]. In hemodialysis patients, 1,25(OH) 2 D 3 supplementation increases 3 RM knee extension, knee extension peak torque and ankle dorsiflexion by 21-38% versus placebo [37], concurrent with an 11% and 15% increase in tibialis anterior and thigh cross-sectional areas, respectively. In a separate study, treating vitamin D deficient elderly women with alphacalcidiol for 6 months increased isometric knee extensor strength by 13% and total walking distance traveled over 2 min by 10% versus baseline [38].…”

Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM)

“…168 Vitamin D and/or parathyroid hormone have long been considered contributors to PEW, and vitamin D appears to be involved in some key molecular pathways for PEW and muscle regulation. 169 Experimental animal models of kidney failure and humans show improvements in muscle size and strength, markers of muscle metabolism, and/or serum albumin with replacement of 1,25-dihydroxyvitamin D. 170,171 Finally, there is a positive association between 25-hydroxyvitamin D and testosterone levels, suggesting an additional mechanism in which vitamin D may regulate muscle mass. 172 Symptoms of depression are more frequent with reduction in kidney function and relate to poor outcome and mortality.…”