Comparison of Serum Vitamin D Levels Among Patients With Chronic Kidney Disease, Patients in Dialysis, and Renal Transplant Patients E. Çankayaa,*, Y. Bilenb, M. Keles¸c, A. Uyanıka, M. Akbas¸d, A. Güngöre, S¸. Arslanf, and B. Aydınlıf a Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey; bDepartment of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey; cDepartment of Nephrology, Faculty of Medicine, Mevlana University, Konya, Turkey; d Mengücek Veterans Education and Research Hospital Endocrinology Clinic, Erzincan University, Erzincan, Turkey; eDepartment of Endocrinology, Faculty of Medicine, Atatürk University, Erzurum, Turkey; and fDepartment of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
ABSTRACT Objective. Vitamin D is a hormone with a variety of functions, and its deficiency and insufficiency are commonly seen both in the general population and in patients with chronic renal disease. The aim of this study was to compare vitamin D levels in patients with chronic renal disease who are on hemodialysis, peritoneal dialysis, or no renal replacement therapy and patients who underwent renal transplantation. Methods. A total of 169 patients who had not used vitamin D for 1 year and who had no diabetes mellitus or proteinuria were included in the study. These included: 40 patients with renal transplantation, 40 patients on hemodialysis, 49 patients on peritoneal dialysis, and 40 patients with chronic renal failure stage 1, 2, 3, or 4. 25-Hydroxy vitamin D levels were evaluated in the sera of the patients. Results. 25-Hydroxy vitamin D levels in patients with renal transplantation and in predialysis patients were 12.74 10.24 ng/mL and 11.16 12.25 ng/mL, respectively. The levels were 7.77 6.71 ng/mL and 5.96 4.87 ng/mL in patients on hemodialysis and peritoneal dialysis, respectively. Conclusions. Vitamin D levels are lower in patients on hemodialysis and peritoneal dialysis compared with the patients with renal transplantation for a variety of reasons. In this study, objective results were obtained supporting the administration of vitamin D supplements without glomerular filtration rate measurement in all patient groups with the diagnosis of chronic renal failure in accordance with the guidelines.
A
MONG the important functions of vitamin D are the regulation of serum concentrations of calcium and phosphorus, suppression of parathyroid hormones, muscular coordination, and regulation of bone mineralization [1,2]. The major sources of vitamin D are sunlight and diet [3]. Deficiency and insufficiency of vitamin D can be due to a variety of causes. Premature birth, pigmented skin, low sun exposure, obesity, malabsorption, bacterial infection, autoimmune disease, cancer, chronic kidney disease (CKD), and old age are some of the causes [4]. Recent studies have suggested that vitamin D deficiency is a risk factor for mortality in the general population as well as in end-stage renal disease (ESRD) [5e8]. Serum vitamin D level is found to be significantly lower in individuals with severe decrease in glomerular filtration rate
(GFR) compared with participants with normal renal function [9]. Vitamin D supplement administration is recommended in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, regardless of the stage of CKD. Serum vitamin D levels have been evaluated in some studies performed on patients with CKD on hemodialysis (HD) and peritoneal dialysis (PD) and in patients with stages 1, 2, 3, and 4 CKD and renal transplantation (RT), either in separate or in paired groups. In general, vitamin D levels were reported to be deficient and insufficient in those studies. The present researchers have not encountered a *Address correspondence to Erdem Çankaya, MD, Department of Nephrology, Medical Faculty, Atatürk University, 25240 Erzurum, Turkey. E-mail: [email protected]
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.04.036
Transplantation Proceedings, 47, 1405e1407 (2015)
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ÇANKAYA, BILEN, KELES¸ ET AL Table 1. Primary Characteristics and Vitamin (Vit) D Levels of Patients With RT, PD, HD, and CKD Stages 1, 2, 3, and 4 RT
Age, y Sex (M) BMI 25-OH Vit D PTH Ca2þ P ALP BP(s) BP(d)
37.23 12.37 20 25.44 4.91 12.7 10.2 76 32 9.3 0.3 3 0.5 92 46 121 22 75 8
CKD
HD
53.39 11.33 20 27.85 6.28 11.1 12.2 180 92* 9.2 0.4 4 0.7* 111 66 136 9* 86 4*
PD †
48.88 14.33 20 23.03 4.12† 7.7 6.7* 278 125*,† 9.2 0.5 4.4 1.1* 136 79* 138 9* 86 5*
48.59 18.11*,† 24 22.55 5.16 5.9 4.8*,† 288 123*,† 9.1 0.4*,†,‡ 4.6 1*,† 99 47‡ 135 11* 85 6*
Abbreviations: RT, renal transplantation; CKD, chronic kidney disease; HD, hemodialysis; PD, peritoneal dialysis; M, male; BMI, body mass index; PTH, parathyroid hormone (ng/mL); Ca2þ, calcium (mg/dL); P, phosphorus (mg/dL); ALP, alkaline phosphatase (U/L); SBP, systolic blood pressure (mm Hg); DBP, diastolic blood pressure (mm Hg). *P < .05 compared with RT. † P < .05 compared with CKD stages 1, 2, 3, and 4. ‡ P < .05 compared with HD.
study comparing vitamin D levels in all of the groups of CKD patients. The present study aimed to compare the vitamin D levels in all these groups. MATERIALS AND METHODS A total of 169 patients who were being followed for CKD at the nephrology outpatient clinics of the Medical School of Ataturk University were included in the study. Patients were evaluated in groups, including 40 patients who had undergone RT
ABSTRACT Objective. Vitamin D is a hormone with a variety of functions, and its deficiency and insufficiency are commonly seen both in the general population and in patients with chronic renal disease. The aim of this study was to compare vitamin D levels in patients with chronic renal disease who are on hemodialysis, peritoneal dialysis, or no renal replacement therapy and patients who underwent renal transplantation. Methods. A total of 169 patients who had not used vitamin D for 1 year and who had no diabetes mellitus or proteinuria were included in the study. These included: 40 patients with renal transplantation, 40 patients on hemodialysis, 49 patients on peritoneal dialysis, and 40 patients with chronic renal failure stage 1, 2, 3, or 4. 25-Hydroxy vitamin D levels were evaluated in the sera of the patients. Results. 25-Hydroxy vitamin D levels in patients with renal transplantation and in predialysis patients were 12.74 10.24 ng/mL and 11.16 12.25 ng/mL, respectively. The levels were 7.77 6.71 ng/mL and 5.96 4.87 ng/mL in patients on hemodialysis and peritoneal dialysis, respectively. Conclusions. Vitamin D levels are lower in patients on hemodialysis and peritoneal dialysis compared with the patients with renal transplantation for a variety of reasons. In this study, objective results were obtained supporting the administration of vitamin D supplements without glomerular filtration rate measurement in all patient groups with the diagnosis of chronic renal failure in accordance with the guidelines.
A
MONG the important functions of vitamin D are the regulation of serum concentrations of calcium and phosphorus, suppression of parathyroid hormones, muscular coordination, and regulation of bone mineralization [1,2]. The major sources of vitamin D are sunlight and diet [3]. Deficiency and insufficiency of vitamin D can be due to a variety of causes. Premature birth, pigmented skin, low sun exposure, obesity, malabsorption, bacterial infection, autoimmune disease, cancer, chronic kidney disease (CKD), and old age are some of the causes [4]. Recent studies have suggested that vitamin D deficiency is a risk factor for mortality in the general population as well as in end-stage renal disease (ESRD) [5e8]. Serum vitamin D level is found to be significantly lower in individuals with severe decrease in glomerular filtration rate
(GFR) compared with participants with normal renal function [9]. Vitamin D supplement administration is recommended in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, regardless of the stage of CKD. Serum vitamin D levels have been evaluated in some studies performed on patients with CKD on hemodialysis (HD) and peritoneal dialysis (PD) and in patients with stages 1, 2, 3, and 4 CKD and renal transplantation (RT), either in separate or in paired groups. In general, vitamin D levels were reported to be deficient and insufficient in those studies. The present researchers have not encountered a *Address correspondence to Erdem Çankaya, MD, Department of Nephrology, Medical Faculty, Atatürk University, 25240 Erzurum, Turkey. E-mail: [email protected]
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.04.036
Transplantation Proceedings, 47, 1405e1407 (2015)
1405
1406
ÇANKAYA, BILEN, KELES¸ ET AL Table 1. Primary Characteristics and Vitamin (Vit) D Levels of Patients With RT, PD, HD, and CKD Stages 1, 2, 3, and 4 RT
Age, y Sex (M) BMI 25-OH Vit D PTH Ca2þ P ALP BP(s) BP(d)
37.23 12.37 20 25.44 4.91 12.7 10.2 76 32 9.3 0.3 3 0.5 92 46 121 22 75 8
CKD
HD
53.39 11.33 20 27.85 6.28 11.1 12.2 180 92* 9.2 0.4 4 0.7* 111 66 136 9* 86 4*
PD †
48.88 14.33 20 23.03 4.12† 7.7 6.7* 278 125*,† 9.2 0.5 4.4 1.1* 136 79* 138 9* 86 5*
48.59 18.11*,† 24 22.55 5.16 5.9 4.8*,† 288 123*,† 9.1 0.4*,†,‡ 4.6 1*,† 99 47‡ 135 11* 85 6*
Abbreviations: RT, renal transplantation; CKD, chronic kidney disease; HD, hemodialysis; PD, peritoneal dialysis; M, male; BMI, body mass index; PTH, parathyroid hormone (ng/mL); Ca2þ, calcium (mg/dL); P, phosphorus (mg/dL); ALP, alkaline phosphatase (U/L); SBP, systolic blood pressure (mm Hg); DBP, diastolic blood pressure (mm Hg). *P < .05 compared with RT. † P < .05 compared with CKD stages 1, 2, 3, and 4. ‡ P < .05 compared with HD.
study comparing vitamin D levels in all of the groups of CKD patients. The present study aimed to compare the vitamin D levels in all these groups. MATERIALS AND METHODS A total of 169 patients who were being followed for CKD at the nephrology outpatient clinics of the Medical School of Ataturk University were included in the study. Patients were evaluated in groups, including 40 patients who had undergone RT
