Vitamin D Deficiency Likely Among Kidney Disease Patients Starting Dialysis

Vitamin D deficiency is almost universal among kidney disease patients who have low blood protein levels and who start dialysis during the winter, according to a study appearing in

Vitamin D deficiency is almost universal among kidney disease patients who have low blood protein levels and who start dialysis during the winter, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The research identifies a group of patients who are at extremely high risk of being deficient in vitamin D and provides some clues as to why the deficiency occurs in these individuals.

Vitamin D deficiency is common in patients with end-stage renal disease (ESRD) on dialysis, but it''s not clear which patients are at increased risk. Ishir Bhan, MD, MPH (Massachusetts General Hospital), and his colleagues sought to determine whether routinely measured clinical and demographic characteristics could identify dialysis patients who have a high risk of vitamin D deficiency.

Dialysis - Hemodialysis, Peritoneal Dialysis and Role of Diet and Drugs
Dialysis is an artificial process for removing excess water and waste from the blood. Hemodialysis and peritoneal dialysis are the types of dialysis.

The researchers analyzed data from 908 patients in the Accelerated Mortality on Renal Replacement (ArMORR) cohort, a nationally representative group of U.S. dialysis patients. Data from 60% of the patients were used to find potential predictors of vitamin D deficiency, while data from the other 40% of patients were used to validate the predictors.

The investigators found that 79% of the study population was vitamin D deficient. Black race, female sex, winter season, and low blood levels of the protein albumin (â‰¤ 3.1 g/dL) were the strongest predictors of vitamin D deficiency. In the validation set, the presence of low blood albumin levels and winter season increased the likelihood of vitamin D deficiency in black females (from 90% to 100%), black males (from 85% to 100%), white females (from 82% to 94%), and white males (from 66% to 92%).

"This research identifies risk factors for nutritional vitamin D deficiency in the dialysis population and may provide clues to its biology in this population," said Dr. Bhan. One interpretation of the finding that low blood albumin levels were associated with deficiency is that at-risk patients leak large amounts of protein in their urine. The investigators suspect that vitamin D binding protein, which transports the vitamin through the blood, may also be lost through the urine. Its loss could lead to the loss of vitamin D as well.

Quiz on Kidney
The kidneys are two bean-shaped organs, each about the size of a fist, and are located just below the rib cage, one on each side of your spine.

Healthy kidneys filter about half a cup of blood every minute, removing wastes and extra water to make urine. The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters, one on each side of your bladder. The bladder stores urine. The kidneys, ureters, and bladder are partof the urinary tract.

Protein Catabolic Rate
Find out breakdown rate of proteins in patients suffering from kidney problem and for those undergoing dialysis.

kidneys remove wastes and extra fluid from your body. Kidneys also remove acid that is produced by the cells of your body and maintain a healthy balance of water, salts, and minerals-such as sodium, calcium, phosphorus and potassium-in your blood ().

Without this balance, nerves, muscles, and other tissues in the body may not work normally.

Kidneys also make hormones that help

Control your blood pressure
Make red blood cells
Keep your bones strong and healthy

In addition, while previous studies have suggested that patients on dialysis have an impaired ability to generate vitamin D from sun exposure, these findings emphasize that skin-based production of the vitamin is likely to be important in patients with ESRD.

Study co-authors include Sherri-Ann Burnett-Bowie, MD, MPH, Jun Ye, PhD, Ravi Thadhani, MD MPH (Massachusetts General Hospital), and Marcello Tonelli, MD (University of Alberta, Edmonton, Canada).

Source-Newswise
SRM