The effect of prescribing vitamin D analogues and serum vitamin D status on both contracting COVID‐19 and clinical outcomes in kidney dialysis patients'

Abstract

Aims Vitamin D plays a role in innate immune system activation, and deficiency increases susceptibility to respiratory infections and disease severity including COVID‐19. We determined whether vitamin D levels and medications were associated with contracting COVID‐19, and disease severity defined by hospitalisation and dialysis patient mortality. Methods We reviewed serum vitamin D levels, and prescription of cholecalciferol and alfacalcidol along with corresponding medical records of adult dialysis patients from a United Kingdom tertiary centre between March 2020 and May 2021. COVID‐19 infection was determined by polymerase chain reaction (PCR) results. Results 362 (35%) of 1035 dialysis patients tested PCR positive for COVID‐19. COVID‐19 positive patients had lower native median vitamin D (65 (39–95) versus 74 (40.5–101) nmol/L ( p = .009) despite greater prescription of cholecalciferol (median 20 000 (20000‐20 000) versus 20 000 (0–20 000) IU/week), p < .001, but lower prescription of alfacalcidol 0 (0–3.0) versus 2.0 (0.–5.0) ug/week, p < .001. On multivariate logistic regression COVID‐19 infection was associated with haemodialysis versus peritoneal dialysis ( p < .001), cholecalciferol dose ( p < .001) and negatively with alfacalcidol ( p < .001). However, serum vitamin D levels and alfacalcidol dosages were not significantly different for those requiring hospitalisation compared to those managed at home, although those who died were prescribed lower alfacalcidol dosages. Conclusion Dialysis patients who contracted COVID‐19 had lower levels of native vitamin D prior to COVID‐19 and were prescribed lower dosages of alfacalcidol. However, there was no association between vitamin D status and disease severity. This retrospective observational analysis supports a potential role for vitamin D and susceptibility to COVID‐19 infection in dialysis patients.

The changing pattern of COVID‐19 infection in hemodialysis and peritoneal dialysis patients

“…United Kingdom (UK) approved nasal or nasopharyngeal, COVID-19 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. 11 Patients attending for HD outpatient treatments were then routinely screened for COVID-19 whether symptomatic or not, whereas PD patients were only initially screened when symptomatic, and then as part of community contact tracing programs or when attending hospital clinics for review, and then when home testing programs were rolled out to the general public. 12 In London the predominant COVID-19 variant was the original wild type between March and July 2020, then alpha from August to December 2020, beta from January to May 2021, delta June to December 2021, and then from January 2022 omicron variants.…”

“…Nasal and pharyngeal swabs were tested by COVID‐19 real‐time reverse transcriptase‐polymerase chain reaction (RT‐PCR), initially by the UK Public Health Service laboratory, then subsequently by a UK approved immunoassay (Roche Cobas Immunoassay platform, Roche Diagnostics Ltd, Burgess Hill, UK). United Kingdom (UK) approved nasal or nasopharyngeal, COVID‐19 real‐time reverse transcriptase‐polymerase chain reaction (RT‐PCR) test 11 . Patients attending for HD outpatient treatments were then routinely screened for COVID‐19 whether symptomatic or not, whereas PD patients were only initially screened when symptomatic, and then as part of community contact tracing programs or when attending hospital clinics for review, and then when home testing programs were rolled out to the general public 12 …”

Active vitamin D analog and SARS‐CoV‐2 IgG after BNT162b2 vaccination in patients with hemodialysis

“…A recent study reported that paricalcitol improves survival in hemodialysis patients with COVID‐19 [33]. In addition, patients with CKD, including those on dialysis who are prescribed low‐dose alfacalcidol, are at risk of contracting COVID‐19 [34].…”

Active Vitamin D analog and SARS-CoV-2 IgG after BNT162b2 vaccination in patients with hemodialysis

“…A recent study reported that paricalcitol is associated with improved survival in hemodialysis patients with COVID-19 30 . In addition, patients with CKD, including those on dialysis who are prescribed low-dose alfacalcidol, are at risk of contracting COVID-19 31 .…”