Dilek BARUTÇU ATAŞ, Arzu VELİOĞLU, Murat TUĞCU, Hakkı ARIKAN, Ebru AŞÇIOĞLU

Prevalence and predictors of 25-OH Vitamin D deficiency in peritoneal dialysis patients: A single center study

Vitamin D has a critical role in bone-mineral disorders in chronic kidney disease (CKD) and its deficiency is further associated with increased cardiovascular morbidity and mortality among CKD patients. We aimed to evaluate prevalence of vitamin D deficiency and investigate the laboratory and clinical parameters associated with 25-OH vitamin D deficiency in peritoneal dialysis (PD) patients. Sixty-four (33M/31F) peritoneal dialysis patients were enrolled in this retrospective single center study. Clinical and laboratory data were obtained from patient charts. Prevalence of 25-OH vitamin D deficiency and its associations were analyzed. The patients’ mean age was 49.7±13.3 years and the mean duration of PD was 61.0±55.0 months. The mean 25-OH vitamin D level was 8.9±2.4 ng/ml and none of the patients were on 25-OH vitamin D therapy. All of the patients had lower than normal 25-OH vitamin D levels according to KDOQI guidelines. Levels of 25-OH vitamin D were deficient and insufficient in 84.4% (57.8% mild; 26.6% severe) and 15.6% of the patients, respectively. There was no association between 25-OH vitamin D levels and sex, age, BMI, duration of PD and cause of ESRD. There was a negative correlation between 25-OH vitamin D levels and uric acid and parathyroid hormone. Uric acid was an independent predictor of 25-OH vitamin D deficiency in the logistic regression analysis [OR (95%CI): 0.139 (0.029-0.667), p: 0.014]. We conclude that 25-OH vitamin D deficiency is very common in PD patients. Serum uric acid is an independent predictor of 25-OH vitamin D deficiency which should further be investigated in larger studies.

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Amer M, Qayyum R. Relationship between 25-hydroxyvitamin D and all-cause and cardiovascular disease mortality. Am J Med. 2013;126:509-14.

Souberbielle JC, Body JJ, Lappe JM, et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun Rev. 2010;9:709-15.

London GM, Guérin AP, Verbeke FH, et al. Mineral metabolism and arterial functions in end-stage renal disease: potential role of 25-hydroxyvitamin D deficiency. J Am Soc of Nephrol. 2007;18:613-20.

Gracia-Iguacel C, Gallar P, Qureshi AR, et al. Vitamin D deficiency in dialysis patients: effect of dialysis modality and implications on outcome. J Ren Nutr. 2010;20:359-67.

Taskapan H, Ersoy FF, Passadakis PS, et al. Severe vitamin D deficiency in chronic renal failure patients on peritoneal dialysis. Clin Nephrol. 2006;66:247–55.

González EA, Sachdeva A, Oliver DA, et al. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol. 2004;24:503-10.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-81.

Brancaccio D, Cozzolino M. Cardiovascular effects of VDR and CaSR activation. G Ital Nefrol. 2009;26:18-22.

Rojas-Rivera J, De La Piedra C, Ramos A, et al. The expanding spectrum of biological actions of vitamin D. Nephrol Dial Transplant. 2010; 25:2850-65.

Melamed ML, Michos ED, Post W, et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168:1629-37.

Ulutas O, Taskapan H, Taskapan MC, et al. Vitamin D deficiency, insulin resistance, serum adipokine, and leptin levels in peritoneal dialysis patients. Int Urol Nephrol. 2013;45:879-84.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009;(113):1-130.

Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J Pharmacol Pharmacother. 2012;3:118-26.

Alpdemir M, Alpdemir MF. Vitamin D deficiency status in Turkey: A meta-analysis. Int J Med Biochem. 2019;2:118-31.

Cho HY, Hyun HS, Kang HG, et al. Prevalence of 25(OH) Vitamin D insufficiency and deficiency in pediatric patients on chronic dialysis. Perit Dial Int. 2013;33:398-404.

Shah N, Bernardini J, Piraino B. Prevalence and correction of 25(OH) Vitamin D deficiency in peritoneal dialysis patients. Perit Dial Int. 2005;25:362-6.

Marinelli A, Pistolesi V, Rossi V, et al. Severe 25-OH vitamin D deficiency in patients on chronic hemodialysis. G Ital Nefrol. 2014;31:gin/31.5.7.

Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32:S112-9.

Wang AY, Lam CW, Sanderson JE, et al. Serum 25-hydroxyvitamin D status and cardiovascular outcomes in chronic peritoneal dialysis patients: a 3-y prospective cohort study. Am J Clin Nutr. 2008;87:1631-8.

Matias PJ, Ferreira C, Jorge C, et al. 25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in hemodialysis patients. Nephrol Dial Transplant. 2009;24:611-8.

Demir M, İçaçan G, Yakar B, et al. The effect of paricalcitol on Hepatitis B immunization in hemodialysis patients. Med Sci Discov.,2020;7:549-53.

Fayed A, Nokeetya MM, Heikalb AA, et al. Urine albumin and serum uric acid are important determinants of serum 25 hydroxyvitamin D level in pre-dialysis chronic kidney disease patients. Ren Fail. 2019;41:540-6.

Sipahi S, Acikgoz SB, Genc AB, et al. The association of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid levels, and microalbuminuria in patients with type 2 diabetes and chronic kidney disease. Med Princ Pract. 2017;26:146–51.

Dalbeth N, Horne A, Gamble GD, et al. The effect of calcium supplementation on serum urate: analysis of a randomized controlled trial. Rheumatology (Oxford). 2009;48:195–7.

Hui JY, Choi JW, Mount DB, et al. The independent association between parathyroid hormone levels and hyperuricemia: a national population study. Arthritis Res Ther. 2012;14:R56.

Emilion E, Emilion R. Estimation of the 25(OH) vitamin D threshold below which secondary hyperparathyroidism may occur among African migrant women in Paris. Int J Vitam Nutr Res. 2011;81:218–24.

Miller PD, Schwartz EN, Chen P, et al. Teriparatide in postmenopausal women with osteoporosis and mild or moderate renal impairment. Osteoporos Int. 2007;18:59–68.

Peng H, Li H, Li C, et al. Association between vitamin D insufficiency and elevated serum uric acid among middle‐aged and elderly Chinese Han women. PLoS One. 2013;8:e61159.