Prevalence of Vitamin D [25(OH)D] Deficiency and Effects of Supplementation With Ergocalciferol (Vitamin D₂) in Stage 5 Chronic Kidney Disease Patients

Objective

This study investigated the prevalence of vitamin D deficiency, its association with nutrition-related parameters, and the effects of ergocalciferol supplementation in stage 5 chronic kidney disease (CKD). Measures of interest included serum albumin, glycosylated hemoglobin (HgA1c), hemoglobin, phosphorus, corrected calcium, parathyroid hormone (iPTH), equilibrated normalized protein catabolic rate (enPCR), and quality-of life-survey physical component score (SF-36 PCS).

Design and Setting

This retrospective study was conducted at five dialysis centers in western Massachusetts. Patient records were examined for a 6-month period in 2006, after initiation of a protocol to assess serum 25(OH)D and implement treatment with ergocalciferol if the level of serum 25(OH)D were <40 ng/mL.

Results

Over 90% (i.e., 92.4%) of patients had vitamin D levels of less than 40 ng/mL; 80% had vitamin D levels at 31 ng/mL or less. Ergocalciferol supplementation (50,000 IU/week × 24) was associated with significant improvements in serum 25(OH)D from baseline (18.4 ± 9.0 ng/mL; mean ± SD) to 6 months (42.0 ± 24.7 ng/mL) (P < .0005). The level of glycosylated hemoglobin decreased from 6.9% ± 1.9% at baseline to 6.4% ± 1.5% at 6 months (P < .0005), while hemoglobin improved from 12.1 ± 1.6 g/dL to 12.3 ± 1.4 g/dL (P < .0005). Corrected calcium decreased from 8.7 ± 0.8 mg/dL to 8.5 ± 0.9 mg/dL at 6 months (P = .002). Phosphorus and iPTH exhibited a downward trend, though not significantly. Albumin remained stable, while enPCR increased (0.91 ± 0.23 at baseline, vs. 0.98 ± 0.32 at 6 months) (P = .01). The SF-36 PCS scores did not differ significantly from baseline (35.4 ± 11.8) at 6 months (35.0 ± 11.1).

Conclusions

Vitamin D [25(OH)D] deficiency appears to be widely prevalent in stage 5 CKD. Repletion with ergocalciferol may assist in improving glycemic control in the management of diabetes. Additional research is needed to confirm these results and determine the optimal levels of serum 25(OH)D.