Vitamin D and Chronic Kidney Disease
Vitamin D is one of the fat-soluble vitamins. It has been recognized for over a century that Vitamin D is necessary for healthy bone growth through the actions of Vitamin D on calcium absorption.
A lack of Vitamin D is responsible for the now, fortunately rare, condition of defective bone growth called rickets.
Vitamin D is also active in controlling cell turnover, called cell proliferation. As such, Vitamin D may be helpful in cancer suppression. Vitamin D may also play a part in cardiac health and other immune functions.
Natural Vitamin D is processed from a precursor in the skin to an active form by the action of ultraviolet light. Vitamin D also requires further processing to become active in both the liver and the kidneys.
Patients with kidney function may make insufficent amounts of active Vitamin D and require supplementation.
How much Vitamin D is necessary or ideal for overall good health has come into question in the last few years. Most vitamin concentrations in the body require a delicate balance between too much and too little, as both may have harmful side effects. Please discuss your Vitamin D requirements with your health care provider.
We will list relevant articles from the Vitamin D literature as they become available.
Author Interview: Ravi Thadhani, MD, MPH
Vitamin D Therapy and Cardiac Structure and Function in Patients With Chronic Kidney Disease
The PRIMO Randomized Controlled Trial
Ravi Thadhani, Evan Appelbaum, Yili Pritchett, Yuchiao Chang, Julia Wenger, Hector Tamez, Ishir Bhan, Rajiv Agarwal, Carmine Zoccali, Christoph Wanner, Donald Lloyd-Jones, Jorge Cannata, B. Taylor Thompson, Dennis Andress, Wuyan Zhang, David Packham, Bhupinder Singh, Daniel Zehnder, Amil Shah, Ajay Pachika, Warren J. Manning, Scott D. Solomon
JAMA. 2012;307(7):674-684.doi:10.1001/jama.2012.120
|
David M Spiegel and Kate Brady
Kidney International (1 February 2012) |doi:10.1038/ki.2011.490
|
David M. Spiegel, Lesley McPhatter, Ann Allison, Joanne C. Drumheller, and Robert Lockridge
CJASN CJN.08170811; published ahead of print February 2012 doi:10.2215/CJN.08170811
|
Meri J. Ala-Houhala, Katja Vähävihu, Taina Hasan, Hannu Kautiainen, Erna Snellman, Piia Karisola,
Yvonne Dombrowski, Jürgen Schauber, Heikki Saha, and Timo Reunala
Nephrol.Dial. Transplant. doi:10.1093/ndt/gfr700
|
Magdalene M. Assimon Pharm.D, Page V. Salenger MD, Hassan A.N. El-Fawal PhD, Darius L. Mason Pharm.D., BCPS
Nephrology
DOI: 10.1111/j.1440-1797.2011.01555.x
|
|
Author Interview: T. Christopher Bond, Ph.D.
Effects of Switching from Intravenous Paricalcitol to Doxercalciferol on Dialysis Patient Bone and Mineral Outcomes
T. Christopher Bond, PhD, Steven M. Wilson, PhD, Mahesh Krishnan, MD, FASN, Tracy Jack Mayne, PhD.
DaVita Clinical Research, Minneapolis, MN.
ASN 2011 Abstract: [FR-PO1266]
|
1Department Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain.
Guerrero F, Montes de Oca A, Aguilera-Tejero E, Zafra R, Rodríguez M, López I.
Nephrol Dial Transplant. 2011 Oct 24.
|
|
Fiedler R, Dorligjav O, Seibert E, Ulrich C, Markau S, Girndt M.Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
Nephron Clin Pract. 2011 Aug 11;119(3):c220-c226
|
de Boer IH, Katz R, Chonchol M, Ix JH, Sarnak MJ, Shlipak MG,
Siscovick DS, Kestenbaum B.
Clin J Am Soc Nephrol. 2011 Aug 11.
|
Author Interview: Dr. Giuseppe Cianciolo
VDR Expression on Circulating Endothelial Progenitor Cells in Dialysis Patients Is Modulated by 25(OH)D Serum Levels and Calcitriol Therapy.
Cianciolo G, La Manna G, Cappuccilli ML, Lanci N, Della Bella E, Cuna V, Dormi A, Todeschini P, Donati G, Alviano F, Costa R, Bagnara GP, Stefoni S.
Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy.
Blood Purif. 2011 Jul 9;32(3):161-173.
|
Figuiredo-Dias V, Cuppari L, Garcia-Lopes MG, de Carvalho AB, Draibe SA, Kamimura MA.
J Ren Nutr. 2011 Jun 6.
Nutrition Program, Federal University of São Paulo, São Paulo, Brazil
|
Author Interview: Dr. KS Kant
Converting to Doxercalciferol Capsules From Intravenous Paricalcitol or Doxercalciferol.
Kant KS, Gonzalez AR, Hariachar S, Bernardo M, Duggal A, Engstrand S, Hunter J, Plone M, Hertel J.
J Ren Nutr. 2011 Jun 6.
Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
|
|
|
Author Interview: Dr. Roberto Pecoits-Filho
Hypovitaminosis D Is Associated with Systemic Inflammation and Concentric Myocardial Geometric Pattern in Hemodialysis Patients with Low iPTH Levels
Bucharles S, Barberato SH, Stinghen AE, Gruber B, Meister H, Mehl A, Piekala L, Dambiski AC, Souza A, Olandoski M, Pecoits-Filho R.
Nephron Clin Pract. 2011 Feb 16;118(4):c384-c391.
Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. |
|
|
|
|
Eur Heart J. 2010 Aug 5.
Drechsler C, et al
Department of Internal Medicine 1, Division of Nephrology, University of Würzburg, Oberdürrbacher Str. 6, D-97080 Würzburg, Germany.
|
Semin Dial. 2010 Jul;23(4):407-10.
Bhan I, Hewison M, Thadhani R.
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
|
|
|
|
|
|
This article reports on the low levels of Vitamin D found in non-Hispanic patients of color and increased levels of chronic kidney disease. The authors report that this is an association but does not necessarily imply causation.
|
|
This study highlights factors that increase the risk of Vitamin D deficiency, including:
Black race, female sex, winter season, and hypoalbuminemia ( low level of albumin, a blood protein).
The authors concluded: Deficiency of 25-hydroxyvitamin D is nearly universal among patients with hypoalbuminemia initiating chronic hemodialysis in winter.
|
|
tags and keywords: kidney disease, dialysis, hemodialysis, chronic kidney disease, nephrology, kidney failure, renal diets, diets for chronic kidney disease, dialysis diets, kidney diet, vitamin D, CKD
|
Author Interviews: hemodialysis
- Dialysis - ESRD - CKD |
| Vitamin D Therapy & Cardiac Structure & Function in CKD Dr. Thadhani JAMA |
| A model to predict optimal dialysate flow Dr. Ahmed: Therapeutic Apheresis & Dialysis |
Low Molecular Weight Iron Dextran Increases FGF-23 with PTH Decrease in Hemodialysis: Dr. Hryszko
Therapeutic Apheresis & Dialysis |
| Differences Between Dialysis Modality Selection and Initiation Dr. Liebman Amer J. Kidney Diseases |
| Right intra-atrial catheter placement for hemodialysis in patients with multiple venous failure Dr. Oguz Hemodialysis Int'l |
| Acute dialysis risk in living kidney donors Dr. Lam: Nephrology Dialysis Transplant |
| Mortality Associated with Dose Response of Erythropoiesis-Stimulating Agents in Hemodialysis vs Peritoneal Dialysis Drs. Molnar & Dr. Kam Kalantar-Zadeh Amer J Nephrology |
| Event-related distress in kidney disease patients: S. Ramer Nephrology Dialysis Transplant |
Impact of nephrotic edema of lower limbs on obstructive sleep apnea: Drs Lai & Tang
Nephrology Dialysis. Transplant |
Geriatric Nutritional Risk Index as Predictor of Mortality in Korean Hemodialysis: Dr. Shin
Therapeutic Apheresis & Dialysis |
| Decreased Kidney Function Among Agricultural Workers in El Salvador: Dr. Wesseling Am J Kidney Dis. |
| Protein Oxidative Stress & Dyslipidemia in Dialysis: M.de Mattos Therapeutic Apheresis & Dialysis |
| Effect of hemodialysis and hemofiltration on plasma C.E.R.A. concentrations : Dr.Reigner Hemodialysis International |
| Intake of Antioxidants and their Status in Chronic Kidney Disease : Dr. Gupta J Renal Nutrition |
| Antidepressive Agents & Mortality in ESRD : Dr. Tsai Nephrology |
| Overweight, obesity & intentional weight loss in CKD : NHANES Dr. Navaneethan Int'l J. of Obesity |
| Variation in Oral Calcitriol Response in Patients With Stages 3-4 CKD: Dr. Shoben: Amer J Kidney Diseases |
| Calcium balance in normal individuals & CKD patients on low &high-calcium diets: Dr. Spiegel Kidney International |
Depressive symptoms associate with high mortality risk & dialysis withdrawal in incident hemodialysis patients:
Dr. Lacson Nephrology Dialysis Transplant |
| Global Trends in Rates of Peritoneal Dialysis: Dr. Jain JASN |
Structural Equation Modeling Highlights the Potential of Kim-1 as CKD Biomarker: Dr. Gardiner
Am J Nephrology |
| Protective effects of PPARγ agonist in acute nephrotic syndrome: Dr. Fogo Nephrology Dialysis Transplant |
| A Computerized Treatment Algorithm Trial to Optimize Mineral Metabolism in ESRD: Dr. Spiegel CJASN |
Development/Validation of Expedited 10g Protein Counter for Dietary Protein Intake : SL Lim
J.Renal Nutrition |
| IL-6-independent risk factor for ESAs resistance in hemodialysis pts without iron deficiency: Dr. Kim Hemodialysis Int'l |
| Troponin I & Postoperative Myocardial Infarction after Renal Transplantation : Dr. Shroff Amer J Nephrology |
| Longitudinal Progression Trajectory of GFR in CKD: Dr. Li : AJ Kidney Disease |
| Predictors of eGFR Decline in Type 2 Diabetes & Preserved Kidney Function: Dr. Chonchol CJASN |
| Tenecteplase for improvement of blood flow in dysfunctional hemodialysis catheters: Dr. Goldman Clin Neph |
| Religious coping, psychological distress and quality of life in hemodialysis: Dr. Carvalho J Psychosom Res. |
| Effect of captopril on recuperation from ischemia/reperfusion-induced AKI Nephrology Dialysis Transplant |
| Restless legs syndrome in dialysis: comparison of hemodialysis & CAPD: Dr. Merlino Neurol Sci. |
| International practice patterns & non-conventional hemodialysis utilization : Dr. Sood BMC Nephrology |
| Decreased PON1 in hemodialyzed & renal transplanted patients. Dr. Paragh Nephrol. Dial. Transplant |
| Preoperative Proteinuria & Long-Term Progression to Chronic Dialysis & Mortality after CABG: Drs. Chao & Ko : PLoS ONE |
| Creatinine generation is reduced in CVHD & predicts mortality: Dr. Wilson: Nephrology Dialysis Transplant |
Importance of normohydration for the long-term survival in hemodialysis : Dr. Wabel
Nephrology Dialysis Transplant |
| Local Tissue Renin-Angiotensin System Activation in Cardiorenal Metabolic Syndrome & Type 2 Diabetes: Dr.Hayden Cardiorenal Med |
| Group I nonreciprocal inhibition in restless legs syndrome secondary to CKD : Dr. Marconi Parkinsonism & Related Disorders |
Low-Dose ESAs and CV Geometry in CKD: Is Darbepoetin-α More Effective than Expected? Dr. Di Lullo
Cardiorenal Med |
Pharmacotherapy to improve outcomes in vascular access surgery: Dr. Jackson
Nephrology Dialysis Transplant |
| Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone & mineral metabolism in dialysis with uncontrollable secondary hyperparathyroidism. Langenbecks Arch Surg |
| Bisphosphonate Therapy, Death, and Cardiovascular Events Among Female Patients With CKD: Dr. Perkins |
| Losartan prevents the development of the pro-inflammatory monocytes CD14+CD16+ in hemodialysis : Dr. Merino Nephrology Dialysis Transplant |
| Does Dialysis Modality Influence the Oxidative Stress of Uremia? Dr. Capusa Kidney Blood Press Res |
| Treatment of Periodontal Diseases Reduces Inflammation in Hemodialysis : Dr. Siribamrungwong |
| Declining Rates of Deceased Donor Renal Transplantation in the US Over Successive Years of Listing: Dr. Trivedi |
| When Is the Best Moment to Assess the Ankle Brachial Index: Pre- or Post-Hemodialysis?Dr. RM Elias |
| Role of Race and Poverty on Steps to Kidney Transplantation in the Southeastern US |
| Validity & Reliability of the MUST and MST Nutrition Screening Tools in Renal Inpatients : C. Lawson |
| Target-Orientated Algorithm for Regional Citrate-Calcium Anticoagulation in Extracorporeal Therapies: Dr. Brandl |
| Evaluation of bone microarchitecture by HR-pQCT in hemodialysis : Dr. Negri |
| Erectile Dysfunction in Chronic Hemodialysis : Dr. Strippoli |
| Have Renal Dietitians Successfully Implemented Evidence-Based Guidelines Into Practice? E. Joy |
| Regional Citrate Versus Heparin Anticoagulation for CRRT: Drs. Tam & Wu |
| von Willebrand factor predicts mortality in CRRT : Dr. Péquériaux |
| Clinical Outcome of Twice-Weekly Hemodialysis Patients in Shanghai | Dr. Qian |
| Persistently low intact PTH levels predict aortic arch calcification progression in hemodialysis patients : Dr. Song |
| Lack of Awareness among Future Medical Professionals about the Risk of Consuming Hidden Phosphate-Containing Processed Food & Drinks : Dr. Razzaque |
| 51Cr-EDTA plasma & urinary clearance as a measure of residual renal function in dialysis :Dr. Kjaergaard |
| Obesity and Mortality Risk among Younger Dialysis Patients: Dr. Hoogeveen |
| Solar-Assisted Hemodialysis: Dr. Agar |
| Hydrogen sulfide inhibits high glucose-induced matrix protein synthesis by activating AMP-activated protein kinase in renal epithelial cells Drs. Lee & Kasinath |
| Mineral, bone disorders, survival in hemodialysis with & without PKD : Drs. Molnar & Kalantar-Zadeh |
| Hydrogen sulfide inhibits high glucose-induced matrix protein synthesis by activating AMP-activated protein kinase in renal epithelial cells Drs. Lee & Kasinath |
| Mineral, bone disorders, survival in hemodialysis with & without PKD : Drs. Molnar & Kalantar-Zadeh |
| Downregulation of the renal & hepatic hydrogen sulfide-producing enzymes and capacity in CKD - Dr. Vaziri |
| A predictive algorithm for management of anemia in hemodialysis based on ESA pharmacodynamics : Dr. Lines |
| Factors Associated With Intradialytic Systolic Blood Pressure Variability: Dr. Flythe |
| Safety and predictors of complications of renal biopsy in the outpatient setting : Dr. Jiang |
| Heparin induced antibodies in chronic hemodialysis patients and cardiac surgery patients: Dr. Shavit |
| Atrial Fibrillation in Medicare/Medicaid-eligible dialysis patients: Dr. Wetmore |
| Newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: J. Saldanha |
| Correction of Post kidney Transplant Anemia Reduces Progression of Allograft Nephropathy: Dr. Choukrou |
| Mild and moderate pre-dialysis CKD is associated with increased coronary artery calcium: Dr. Budoff |
| Endogenous factors modified by hemodialysis and accuracy of blood glucose-measuring device: Dr. Ogawa |
| Narrow-band UVV increases serum vitamin D levels in hemodialysis patients Dr. Ala-Houhala |
| Predicting hospital cost in CKD patients through blood chemistry values: Dr. Bessette |
| Nutritional vitamin D supplementation in hemodialysis: a potential vascular benefit? D. Mason |
| Volume excess in chronic hemodialysis effects of treatment frequency & treatment spacing : Dr. Schneditz |
| Acid reduction with fruits/veges or bicarb attenuates kidney injury in hypertensive nephropathy with reduced GFR |
Predicting Number of US Medical Graduates Entering Adult Nephrology Fellowships
Using Search Terms Dr. Desai |
| Potential influence of sevelamer hydrochloride on responsiveness to ESAs in hemodialysis patients: Dr. Ikee |
| Anemia Management in Dialysis : ESAs vs Transfusions: Clinical & Economic Consequences :Dr. Naci |
| Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury: Dr. Perkins |
DOPPS Practice Monitor: Update on Trends in US Hemodialysis Care Following Launch of Bundled Payment System and Revisions to ESA Labels |
Emerging trends in hemodialysis care through August 2011, based on a sample of US dialysis facilities, are included in the latest update to the DOPPS Practice Monitor (DPM, at http://www.dopps.org/DPM), run by the Dialysis Outcomes and Practice Patterns Study (DOPPS) at Arbor Research Collaborative for Health.
Ongoing Changes in the US Dialysis Environment – Recent changes in dialysis payment and regulatory guidance are expected to affect hemodialysis practice. In January 2011, the Centers for Medicare & Medicaid Services (CMS) launched a new Prospective Payment System (PPS) with the intent to control dialysis costs through bundled payments. In June 2011, the FDA approved revised prescribing information for erythropoiesis-stimulating agents (ESAs), used to treat anemia in most dialysis patients. Previously, the label recommended a hemoglobin target range of 10-12 g/dL. The June 2011 update removed the target range, advising instead to start ESA therapy for dialysis patients at hemoglobin less than 10 g/dL, and to reduce or interrupt the dose when the hemoglobin approaches or exceeds 11 g/dL.
Most Recent Trends in Care – Over the August 2010 to August 2011 time period, many hemodialysis practices have remained stable; examples include nutrition measures and hemodialysis treatment time and dose. There have been notable trends in the following practice areas:
- Anemia: Hemoglobin levels have decreased since the June 2011 ESA label update. While the mean hemoglobin level declined by 0.12 g/dL over 12 months from August 2010 to July 2011, it declined in August 2011 by another 0.10 g/dL to 11.26 g/dL. The percentage of patients with hemoglobin levels greater than 12 g/dL declined sharply (from 28% to 23%) in July/August 2011, while the percentage with hemoglobin levels less than 10 g/dL increased slightly from 8.5% to 10% and the percentage with hemoglobin levels less than 9 g/dL remained under 3%.
Mean prescribed epoetin dose (among patients receiving epoetin) decreased by 15%, from 21,100 units/wk to 17,900 units/wk, from August 2010 to August 2011, with the greatest decline in June-August 2011. Epoetin doses at the higher end of the dose range have decreased most notably. IV iron use increased from August 2010 to August 2011 though has recently stabilized. In keeping with greater IV iron use, serum ferritin levels (indicative of iron stores) continue to rise. Serum ferritin concentration exceeded 500 ng/mL in 65% of patients, 800 ng/mL in 34% of patients, and 1,200 ng/mL in 11% of patients in August 2011.
- Mineral & Bone Disorder: In our last report, we noted a 29% increase in serum parathyroid hormone (PTH) levels through April 2011, and differences by race were described. Since then, PTH levels have remained stable or declined slightly in both black and non-black patients. In August 2011, 22% of black patients and 12% of non-black patients had very high PTH values (defined here as PTH >600 pg/mL). The percentage of hemodialysis patients for whom PTH is measured has declined slightly since August 2010. There have been no clear changes in serum calcium or serum phosphorus levels.
- Clinical Outcomes: Preliminary data indicate that the 30-day hospitalization rate has increased somewhat from August 2010 to August 2011. The DPM does not report yet on trends in red blood cell transfusions, as dialysis units are often unaware of transfusions occurring in the inpatient setting. Additional efforts to comprehensively monitor trends in transfusions are warranted. To date mortality rate has not changed appreciably, though further follow-up time is necessary as we continue to track this outcome.
Future monitoring of these trends, confirmation with national data when eventually available, and understanding their effect on clinical outcomes, if any, is required.
DPM data are aggregated across dialysis organizations and facilities. Aggregated trends may not reflect trends in individual dialysis organizations or facilities, and are not intended to provide oversight of performance in individual dialysis organizations or facilities.
Read the rest of the DOPPS Practice Monitor: Update on Trends in US Hemodialysis Care Following Launch of Bundled Payment System and Revisions to ESA Labels Press Release |
| |
|
|
| |
Hemodialysis Research Interview of the Week |
Dr. Miklos Z Molnar MD, PhD and Dr. Kam Kalantar-Zadeh MD, MPH, PhD
Harold Simmons Center at Harbor-UCLA. |
Mortality Associated with Dose Response of Erythropoiesis-Stimulating Agents in Hemodialysis versus Peritoneal Dialysis Patients
Duong U, Kalantar-Zadeh K, Molnar MZ, Zaritsky JJ,
Teitelbaum I, Kovesdy CP, Mehrotra R:
Am J Nephrol 2012;35:198-208 (DOI: 10.1159/000335685)
|
What are the main findings of the study? |
The analysis of the data was from a large and contemporary cohort of 10,527 peritoneal dialysis and 139,103 hemodialysis patients in a single dialysis provider with relatively uniform anemia management practice patterns between 7/2001 and 6/2006, i.e., during the era with the highest ESA dose administration in the United
States.
We found that peritoneal dialysis patients with the same achieved hemoglobin levels received substantially lower dose of ESA than hemodialysis patients, and the
differential was even wider among African Americans.
We also found that in peritoneal dialysis patients an ESA dose below 10,000 U/week was not associated with higher mortality, but a 28% higher death risk in those receiving significantly higher dose (>15,000 U/week).
In contrast, higher ESA dose was linearly and incrementally associated with higher all-cause and cardiovascular mortality in hemodialysis.
|
Were any of the findings unexpected?
|
While the administered ESA dose was linearly and incrementally associated with higher mortality in hemodialysis patients, the dose was used in everyday clinical practice in PD patients was not associated with mortality.
Only large doses (>15,000 U/week) were associated with higher mortality risk in PD
population.
|
What should clinicians and patients take away from this study?
|
PD patients require substantially lower ESA dose than hemodialysis to achieve same hemoglobin levels.
In both PD and hemodialysis patients Lower ESA dose (< 15,000 U/week) are safer than higher doses.
|
|
|
hemodialysis Keywords | hemodialysis Tags | hemodialysis Keyword Cloud
|
|
|
