Serum 25(OH)-Cholecalciferol Concentration Is Associated with Hemoglobin Level and Erythropoietin Resistance in Patients on Maintenance Hemodialysis

Abstract

Background: Resistance to erythropoiesis-stimulating agents (ESAs) has been observed in patients with chronic kidney disease (CKD) and it is associated with clinical outcomes. The presence of ESA resistance cannot always be explained by the known risk factors of the condition, suggesting that additional factors may be involved. We wanted to test the hypothesis that vitamin D insufficiency is associated with lower hemoglobin (Hb) and ESA resistance in patients on maintenance hemodialysis (HD). Methods: Data from patients receiving maintenance HD in a single dialysis center were extracted from the medical records in a retrospective chart review. Basic patient characteristics and laboratory data including Hb, serum albumin, intact parathyroid hormone and serum 25(OH)-cholecalciferol (25(OH)D₃) levels were collected. ESA dose and Kt/V were extracted from the dialysis charts. Correlation analysis and multivariate linear regression analysis were used to reveal potential independent associations between clinical and laboratory parameters and ESA resistance. Results: Data from 142 patients were analyzed. Serum 25(OH)D₃ concentration was significantly correlated with Hb (ρ = 0.186, p < 0.05) and also with ESA dose/Hb index (ρ = 0.230, p < 0.01). In multivariable regression analyses, serum 25(OH)D₃ concentration remained significantly associated with both Hb and ESA dose/Hb index after controlling for potentially important confounders. Conclusion: Serum 25(OH)D₃ concentration is independently associated with erythropoietin responsiveness in CKD patients on maintenance HD. If this association will be confirmed, treatment trials looking at the effect of vitamin D supplementation on anemia treatment in CKD patients may be warranted.

Correlation Between Levels of 25-Hydroxy-Vitamin D and Degree of Anemia in Patients with Chronic Kidney Disease

“…Anemia is one of the main complications of the final stages of hemodialysis [8]. Anemia can lead to other comorbidities such as an increase of vascular complications and a decrease in quality of life and an increase of mortality.…”

“…Kiss et al [8] analyzed data from 142 patients in hemodialysis. As in the present work, they found an independent and significant correlation between levels of 25(OH)D and hemoglobin and also an inverse correlation with the dose level of EPO required to maintain hemoglobin levels.…”

Ergocalciferol Supplementation in Hemodialysis Patients With Vitamin D Deficiency: A Randomized Clinical Trial

“…6 A reduction in ESA dose has been found in nonrandomized trials of nutritional vitamin D supplementation in patients on hemodialysis, [6][7][8] and cross-sectional studies show an inverse relationship between serum 25(OH)D and hemoglobin and ESA dose. [9][10][11][12] In vitro and in vivo studies under conditions of vitamin D deficiency have demonstrated increased erythropoeisis with addition of vitamin D. 13,14 The postulated mechanism for nutritional vitamin D's effect is via the suppression of cytokines inhibitory to erythroid progenitors. 14 Increased availability of iron through suppression of hepcidin may also play a role.…”

Metadichol® and Red Cell Distribution Width (RDW) in CKD patients

“…have shown that there is an inverse association between vitamin D levels and EPO CKD patients [25]. Vitamin D supplementation and Paricalcitol therapy have been shown to lead to improvement in biomarkers of inflammation [30][31][32][33][34][35][36][37][38][39][40][41][42].…”