Journal of Renal Nutrition
Volume 20, Issue 6 , Pages 359-367 , November 2010

Vitamin D Deficiency in Dialysis Patients: Effect of Dialysis Modality and Implications on Outcome

  • Carolina Gracia-Iguacel, MD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Paloma Gallar, MD, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Abdul R. Qureshi, MD, PhD

      Affiliations

    • Division of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden
  • ,
  • Olimpia Ortega, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Carmen Mon, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Milagros Ortiz, MD, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Isabel Villarreal, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Concepcion Garcia-Lacalle, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Aniana Olieta, MD, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Maria Sánchez

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Juan C. Herrero, MD, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Ana Vigil, MD, PhD

      Affiliations

    • Division of Renal Medicine, Severo Ochoa University Hospital, Madrid, Spain
  • ,
  • Beng Lindholm, MD, PhD

      Affiliations

    • Division of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden
  • ,
  • Juan J. Carrero, PhD

      Affiliations

    • Division of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden
    • Centre for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
    • Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
    • Corresponding Author InformationAddress reprint requests to Juan Jesús Carrero, PhD Pharm, PhD Med, K56, Division of Renal Medicine and Baxter Novum, CLINTEC, Karolinska University Hospital at Huddinge, 14186 Stockholm, Sweden.

References 

  1. Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164:659–663
  2. Wen CP, Cheng TY, Tsai MK, et al. All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet. 2008;371:2173–2182
  3. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–1305
  4. Stenvinkel P, Carrero JJ, Axelsson J, et al. Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle?. Clin J Am Soc Nephrol. 2008;3:505–521
  5. Ganesh SK, Stack AG, Levin NW, et al. Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12:2131–2138
  6. Kalantar-Zadeh K, Kuwae N, Regidor DL, et al. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int. 2006;70:771–780
  7. Avesani CM, Carrero JJ, Axelsson J, et al. Inflammation and wasting in chronic kidney disease: partners in crime. Kidney Int. 2006;70(Suppl):S8–S13
  8. Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71:31–38
  9. Jean G, Charra B, Chazot C. Vitamin D deficiency and associated factors in hemodialysis patients. J Ren Nutr. 2008;18:395–399
  10. Wolf M, Betancourt J, Chang Y, et al. Impact of activated vitamin D and race on survival among hemodialysis patients. J Am Soc Nephrol. 2008;19:1379–1388
  11. Ravani P, Malberti F, Tripepi G, et al. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int. 2009;75:88–95
  12. 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;87:1631–1638
  13. Michos ED, Melamed ML. Vitamin D and cardiovascular disease risk. Curr Opin Clin Nutr Metab Care. 2008;11:7–12
  14. Mehrotra R, Kermah D, Budoff M, et al. Hypovitaminosis D in chronic kidney disease. Clin J Am Soc Nephrol. 2008;3:1144–1151
  15. Cuppari L, Garcia-Lopes MG. Hypovitaminosis D in chronic kidney disease patients: prevalence and treatment. J Ren Nutr. 2009;19:38–43
  16. Taskapan H, Ersoy FF, Passadakis PS, et al. Severe vitamin D deficiency in chronic renal failure patients on peritoneal dialysis. Clin Nephrol. 2006;66:247–255
  17. Shah N, Bernardini J, Piraino B. Prevalence and correction of 25(OH) vitamin D deficiency in peritoneal dialysis patients. Perit Dial Int. 2005;25:362–366
  18. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383
  19. National Kidney Foundation: K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1–S201
  20. Sherman SS, Hollis BW, Tobin JD. Vitamin D status and related parameters in a healthy population: the effects of age, sex, and season. J Clin Endocrinol Metab. 1990;71:405–413
  21. Matsuoka LY, Wortsman J, Haddad JG, et al. Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol. 1991;127:536–538
  22. Saraiva GL, Cendoroglo MS, Ramos LR, et al. Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of Sao Paulo (23 degrees 34'S). Brazil. Osteoporos Int. 2005;16:1649–1654
  23. Vieth R, Cole DE, Hawker GA, et al. Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D intake does not prevent it. Eur J Clin Nutr. 2001;55:1091–1097
  24. Wolf M, Shah A, Gutierrez O, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int. 2007;72:1004–1013
  25. Ewers B, Gasbjerg A, Moelgaard C, et al. Vitamin D status in kidney transplant patients: need for intensified routine supplementation. Am J Clin Nutr. 2008;87:431–437
  26. Jean G, Terrat JC, Vanel T, et al. Daily oral 25-hydroxycholecalciferol supplementation for vitamin D deficiency in haemodialysis patients: effects on mineral metabolism and bone markers. Nephrol Dial Transplant. 2008;23:3670–3676
  27. Carrero JJ. Identification of patients with eating disorders: clinical and biochemical signs of appetite loss in dialysis patients. J Ren Nutr. 2009;19:10–15
  28. Chmielewski M, Carrero JJ, Stenvinkel P, et al. Metabolic abnormalities in chronic kidney disease that contribute to cardiovascular disease, and nutritional initiatives that may diminish the risk. Curr Opin Lipidol. 2009;20:3–9
  29. Mak RH, Cheung W, Cone RD, et al. Mechanisms of disease: cytokine and adipokine signaling in uremic cachexia. Nat Clin Pract Nephrol. 2006;2:527–534
  30. Lee SW, Russell J, Avioli LV. 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol: conversion impaired by systemic metabolic acidosis. Science. 1977;195:994–996
  31. Prosser DE, Jones G. Enzymes involved in the activation and inactivation of vitamin D. Trends Biochem Sci. 2004;29:664–673
  32. Mak RH. Effect of metabolic acidosis on insulin action and secretion in uremia. Kidney Int. 1998;54:603–607
  33. Cannata-Andia JB, Gomez Alonso C. Vitamin D deficiency: a neglected aspect of disturbed calcium metabolism in renal failure. Nephrol Dial Transplant. 2002;17:1875–1878
  34. Chen H, McCoy LF, Schleicher RL, et al. Measurement of 25-hydroxyvitamin D3 (25OHD3) and 25-hydroxyvitamin D2 (25OHD2) in human serum using liquid chromatography-tandem mass spectrometry and its comparison to a radioimmunoassay method. Clin Chim Acta. 2008;391:6–12
  35. White P, Cooke N. The multifunctional properties and characteristics of vitamin D-binding protein. Trends Endocrinol Metab. 2000;11:320–327
  36. Fehrman-Ekholm I, Lotsander A, Logan K, et al. Concentrations of vitamin C, vitamin B12 and folic acid in patients treated with hemodialysis and on-line hemodiafiltration or hemofiltration. Scand J Urol Nephrol. 2008;42:74–80
  37. Vanholder R, De Smet R, Glorieux G, et al. Review on uremic toxins: classification, concentration, and interindividual variability. Kidney Int. 2003;63:1934–1943
  38. Gil C, Lucas C, Possante C, et al. On-line haemodiafiltration decreases serum TNFalpha levels in haemodialysis patients. Nephrol Dial Transplant. 2003;18:447–448
  39. Van Tellingen A, Grooteman MP, Bartels PC, et al. Long-term reduction of plasma homocysteine levels by super-flux dialyzers in hemodialysis patients. Kidney Int. 2001;59:342–347
  40. Beerenhout CH, Luik AJ, Jeuken-Mertens SG, et al. Pre-dilution on-line haemofiltration vs low-flux haemodialysis: a randomized prospective study. Nephrol Dial Transplant. 2005;20:1155–1163
  41. Penne EL, Blankestijn PJ, Bots ML, et al. Effect of increased convective clearance by on-line hemodiafiltration on all cause and cardiovascular mortality in chronic hemodialysis patients—the Dutch convective transport study (CONTRAST): rationale and design of a randomised controlled trial [ISRCTN38365125]. Curr Control Trials Cardiovasc Med. 2005;6:8
  42. Mandolfo S, Borlandelli S, Imbasciati E. Leptin and beta2-microglobulin kinetics with three different dialysis modalities. Int J Artif Organs. 2006;29:949–955

 BL is employed by Baxter Healthcare Inc. None of the other authors have any other conflict of interest.

PII: S1051-2276(10)00076-2

doi: 10.1053/j.jrn.2010.03.005

Journal of Renal Nutrition
Volume 20, Issue 6 , Pages 359-367 , November 2010