Seasonal variation of vitamin D in patients on hemodialysis

Tolouian, Ramin; Rao, D. Sudhaker; Goggins, M.; Bhat, Saroj; Gupta, Ajay

doi:10.5414/cnp74019

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…Moreover, seasonal changes of vitamin D concentration in the serum were observed-there was a statistically significant difference between the PS (November 2018) and PW (February/March 2019) periods (p = 0.002). This is in line with other studies [6][7][8][9][10][11][12] conducted in various geographical zones, including Central Europe, which reported a higher concentration of serum vitamin D in the spring and summer periods as compared to other seasons throughout the year. Vitamin D level is determined by sun exposure, but it may also be influenced by dietary vitamin D intake.…”

Section: Vitamin D Seasonal Variationsupporting

confidence: 92%

Acute Phase Proteins and Vitamin D Seasonal Variation in End-Stage Renal Disease Patients

Maraj

Hetwer

Dumnicka

et al. 2020

JCM

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End-stage renal disease (ESRD) patients are vulnerable to vitamin D deficiency due to impaired renal hydroxylation, low dietary intake and inadequate sun exposure. Vitamin D plays a role in innate and adaptive immunity and its seasonal variation has been linked to mortality. ESRD is associated with inadequate removal of pro-inflammatory cytokines regulating acute phase protein (APP) synthesis. Our aim was to look for associations between lifestyle factors, diet, and vitamin D seasonal variation and their relationship with selected APPs and calcium-phosphate metabolism. The study included 59 ESRD patients treated with maintenance hemodialysis. A 24-hour dietary recall was conducted in the post-summer (November 2018, PS) and post-winter (February/March 2019, PW) period, and blood was collected for the measurements of serum total vitamin D, α 1 -acid glycoprotein (AGP), C-reactive protein (CRP), albumin, prealbumin (PRE), parathormone, calcium and phosphate. A self-constructed questionnaire gathered information on vitamin D supplementation, sun exposure and physical activity. Higher caloric intake was observed PW compared PS. Less than 15% of participants met the dietary recommendations for energy, protein, fiber, vitamin D and magnesium intake. Vitamin D supplementation was associated with higher serum vitamin D regardless of season. AGP, PRE, albumin, and vitamin D presented seasonal changes (higher values PS). In patients with serum vitamin D below 25 ng/mL, vitamin D seasonal change correlated with CRP and prealbumin change. Phosphate and Ca × P correlated positively with AGP. A low vitamin D serum level could impact the inflammatory process; however, more studies are needed to confirm the relationship.

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Section: Vitamin D Seasonal Variationsupporting

confidence: 92%

Acute Phase Proteins and Vitamin D Seasonal Variation in End-Stage Renal Disease Patients

Maraj

Hetwer

Dumnicka

et al. 2020

JCM

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“…However, 25(OH)D deficiency has been noted to be highly prevalent regardless of geographic location in CKD patients [27]. Similarly, seasonal variation in vitamin D levels is well known with a higher prevalence of vitamin D deficiency during the winter compared to the summer in HD patients [28]. In our cohort, our 6-month follow-up period included the fall and winter months where vitamin D levels would be expected to decrease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of 25-OH Vitamin D Deficiency in a Population of Hemodialysis Patients and Efficacy of an Oral Ergocalciferol Supplementation Regimen

Porter¹,

Gilmartin

Srisakul

et al. 2013

Am J Nephrol

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Background/Aims: Optimal dosing regimens for 25-OH vitamin D (VitD) deficiency are unknown in hemodialysis (HD) patients. Our aim was to evaluate the efficacy of prescribing ergocalciferol supplementation based on KDOQI guidelines for chronic kidney disease (CKD) stages III-IV in HD patients. Methods: We conducted a retrospective study of 96 urban, predominately African-American HD patients at a single-center dialysis unit with VitD insufficiency or deficiency treated with ergocalciferol. Patients were classified as either compliant or non-compliant with supplementation as determined by review of pharmacy records. The primary outcome was VitD levels 6 months after initiation of treatment and secondary outcomes were VitD levels at 11 months, bone/mineral and anemia parameters. Results: The population was predominately African-American (69%) and Hispanic (28%). There were 61 individuals in the compliant group and 35 individuals in the non-compliant group. The compliant group was older but otherwise similar in demographics and co-morbid conditions to the non-compliant group. After 6 months of treatment, the compliant group had a significant increase in VitD level (14.7 ± 6.0 to 28.7 ± 10.0 ng/ml, p < 0.0001) compared to the non-compliant group (14.7 ± 5.5 to 14.8 ± 7.1 ng/ml, p = 0.95). There were no differences in the incidence of hypercalcemia between the two groups. Except for a decrease in phosphorus in the compliant group (5.6 ± 1.6 to 4.9 ± 1.7 mg/dl, p = 0.004), there were no significant difference in bone/mineral or anemia parameters including dosing of darbepoetin. Conclusion: An ergocalciferol-prescribing strategy using the KDOQI guidelines for stage III-IV kidney disease in HD patients with VitD deficiency or insufficiency is inadequate to achieve repletion or maintenance of normal VitD levels.

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“…Seasonal variations of 25(OH)D levels have been reported in both general population and dialysis patients 8, 9, 22 . In general, low 25(OH)D levels have been reported in winter months in previous studies and most studies have classified these into summer and winter months.…”

Section: Discussionmentioning

confidence: 99%

“…Analysis from NHANES III (the Third National Health and Nutrition Examination Survey) showed an inverse association between BMI and 25(OH)D levels in persons with CKD 6 while a longitudinal study found no such associations 7 . While seasonal variations in 25(OH)D levels have been reported in the general population and in dialysis patients, they have not been studied systematically in non-dialysis dependent CKD 8,9 .…”

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confidence: 99%

Low 25-Hydroxyvitamin D Levels and Mortality in Non–Dialysis-Dependent CKD

Navaneethan

Schold

Arrigain³

et al. 2011

American Journal of Kidney Diseases

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Background Low 25 hydroxyvitamin D (25[OH]D) levels are common among patients with non-dialysis-dependent chronic kidney disease (CKD). The associations between low 25(OH)D levels and mortality among non-dialysis dependent CKD patients are unclear. Study Design Retrospective cohort study. Setting & Participants Patients with stages 3–4 CKD (estimated glomerular filtration rate of 15–59 ml/min/1.73m2) (n = 12,673) who had 25(OH)D levels measured after the confirmation of CKD in Cleveland Clinic Health System. Predictor Levels of 25(OH)D categorized into 3 groups: 25(OH)D <15 ng/ml, 15–29 ng/ml. and ≥ 30 ng/ml Outcomes We examined factors associated with low 25(OH)D levels and associations between low 25(OH)D levels and all-cause mortality (ascertained using the Social Security Death Index and our electronic medical record) using logistic regression, Cox-proportional hazard models and Kaplan-Meier survival curves. Measurements 25(OH)D was measured using chemiluminescence immunoassay. Results Out of 12,763 CKD patients, 15% (n=1970) had 25(OH)D <15 ng/ml while 45% (n=5749) had 25(OH)D 15–29 ng/ml. Male gender, African American race, diabetes, coronary artery disease and lower eGFR were significantly associated with 25(OH)D <30 ng/ml. A graded increase in the risk for 25(OH)D <30 ng/ml was evident across increasing BMI levels. Patients who had 25(OH)D levels measured in Fall through Spring had higher odds for 25(OH)D <30 ng/ml. After covariate adjustment, CKD patients with 25(OH)D <15 ng/ml had a 33% increased risk for mortality (95% CI, 1.07–1.65). The 25(OH)D 15–29 ng/ml group did not exhibit a significantly increased risk for mortality (HR, 1.03; 95% CI, 0.86–1.22) compared to patients with 25(OH)D ≥30 ng/ml. Limitations Single center observational study, lack of data on albuminuria and other markers of bone and mineral disorders, and attrition bias Conclusions 25(OH)D <15 ng/ml was independently associated with all-cause mortality in non-dialysis dependent CKD.

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Seasonal variation of vitamin D in patients on hemodialysis

Cited by 14 publications

References 18 publications

Acute Phase Proteins and Vitamin D Seasonal Variation in End-Stage Renal Disease Patients

Acute Phase Proteins and Vitamin D Seasonal Variation in End-Stage Renal Disease Patients

Prevalence of 25-OH Vitamin D Deficiency in a Population of Hemodialysis Patients and Efficacy of an Oral Ergocalciferol Supplementation Regimen

Low 25-Hydroxyvitamin D Levels and Mortality in Non–Dialysis-Dependent CKD

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