Uneingeschränkter Zugang

Prevalence of vitamin D deficiency in Thai patients receiving various modalities of renal replacement therapy

Piyawan Kittiskulnam
Piyawan Kittiskulnam
, 
Paweena Susantitaphonga
Paweena Susantitaphonga
, 
Natavudh Townamchai
Natavudh Townamchai
, 
Khajohn Tiranathanagul
Khajohn Tiranathanagul
, 
Talerngsak Kanjanabuch
Talerngsak Kanjanabuch
, 
Yingyos Avihingsanon
Yingyos Avihingsanon
, 
Kearkiat Praditpornsilpa
Kearkiat Praditpornsilpa
 und 
Somchai Eiam-Ong
Somchai Eiam-Ong
   | 31. März 2017
Asian Biomedicine's Cover Image
Über diesen Artikel
Vorheriger Artikel
Nächster Artikel
Zitieren
Article Category: Original article
Online veröffentlicht: 31. März 2017
Seitenbereich: s39 - s48
DOI: https://doi.org/10.5372/1905-7415.1000.520
Schlüsselwörter
© 2016 Piyawan Kittiskulnam, Paweena Susantitaphong, Natavudh Townamchai, Pisut Katavatin, Khajohn Tiranathanagul, Talerngsak Kanjanabuch, Yingyos Avihingsanon, Kearkiat Praditpornsilpa, Somchai Eiam-Ong
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Laboratory variables in patients receiving dialysis

VariableOL-HDFPD
25(OH)D <15 ng/mL

Deficiency

 (n = 16)		25(OH)D ≥15 ng/mL

Insufficiency

 (n = 16)		PAPD (n = 24)CAPD (n = 13)P
Demographic data
Age (years)51.4±14.357.1 ± 13.90.2664.3 ± 20.065.5 ± 19.30.87
Male sex, n (%)4 (25.0)7 (43.8)0.2610 (41.7)5 (38.5)0.85
Dialysis duration (years)7.6 ± 5.96.4 ± 4.80.544.3 ± 2.23.6±1.70.32
Diabetes, n (%)7 (43.8)5 (31.3)0.4613 (54.2)5 (38.5)0.36
Treatment with RAS blockade, n (%)9 (56.3)4 (25.0)0.0713 (54.2)5 (38.5)0.36
History of peritonitis (%)NANANA11 (45.8)1 (7.7)0.02
Vitamin D status and adequacy of dialysis
25(OH)D (ng/mL)11.4 ± 2.423.9 ± 7.70.0019.3 ± 5.112.7 ± 6.70.09
Kt/V

weekly Kt/V for patients receiving PD; 25(OH)D, 25-hydroxyvitamin D (calcifediol); APD, ambulatory PD; CAPD, continuous ambulatory PD; RAS, renin–angiotensin system; CCl, Creatinine clearance; hs-CRP, high sensitive C-reactive protein; NA, not applicable; iPTH, intact parathyroid hormone; RAS, renin–angiotensin system; URR, urea reduction ratio; nPNA, normalized protein nitrogen;

2.4 ± 0.52.3 ± 0.30.732.2 ± 0.52.1 ± 0.40.41
URR (%)84.6 ± 6.685.8 ± 3.20.52NANANA
Access blood flow (mL/min)832.9 ± 364.91,238.9 ± 384.90.008NANANA
Weekly CCl (mL/min)NANANA61.3 ± 32.364.1±20.10.78
Nutritional variable
Body mass index (kg/m2)25.4 ± 7.720.3±2.90.0221.8 ± 3.622.1 ± 3.70.81
nPNA (g of N/kg/day)1.1 ± 0.31.2 ± 0.50.341.05±0.31.07 ± 0.30.84
Serum albumin (g/dL)4.0 ± 0.44.1 ± 0.50.453.3 ± 0.53.6 ± 0.70.21
Protein loss via dialysate (g/day)NANANA4.7 ± 3.25.1 ± 1.60.66
Bone metabolism and laboratory variable
Hemoglobin (g/dL)10.2±1.111.3 ± 1.30.0211.2 ± 1.310.7 ± 2.10.38
Uric acid (mg/dL)7.4±1.47.7±1.60.646.0±1.65.9 ± 0.70.72
Corrected calcium (mg/dL)9.5 ± 0.99.5 ± 0.70.939.6 ± 0.99.5 ± 0.80.76
Phosphate (mg/dL)4.7±1.55.0±1.10.534.4±1.54.6±1.30.68
iPTH (pg/mL)743.8 ± 505.0454.9 ± 248.10.09518.5±601.9521.9 ± 615.20.98
hs-CRP (mg/L)6.6 ± 9.84.9 ± 4.50.556.3 ± 6.86.7 ± 7.80.88

Laboratory variables in kidney transplant (KT) recipients

VariableKT deceased donor (n=23)KT living, related donor (n=19)P
Demographic data
25(OH)D (ng/mL)13.7 ± 6.017.5 ± 5.70.046
Age (years)48.5±10.548.1 ± 13.30.91
Male sex, n (%)12 (52.2)8 (42.1)0.52
Post transplantation time (years)7.6 ± 5.76.5 ± 5.40.51
Treatment with RAS blockade, n (%)7 (30.4)4 (21.1)0.49
Diabetes, n (%)5 (21.7)2 (10.5)0.33
Immunosuppressive regimen
Prednisolone use, n (%)12 (52.2)14 (73.7)0.15
Tacrolimus-based, n (%)8 (34.8)9 (47.4)0.41
Renal functions and urine collection
Blood urea nitrogen (mg/dL)27.4±15.321.1±19.60.25
Creatinine (mg/dL)1.9±2.21.5±1.50.45
24-Hour urine protein (g/day)1.7±2.80.4±0.30.045
Nutritional variables and other laboratory findings
Body mass index (kg/m2)23.1±4.223.2±4.40.97
Albumin (g/dL)3.9±0.54.3±0.40.02
nPNA (g of N/kg/day)1.1±0.30.9±0.20.049
Hemoglobin (g/dL)11.8±1.712.1±1.60.55
Fasting blood sugar (mg/dL)93.9±18.5109.9±57.30.21
Uric acid (mg/dL)6.9±2.56.8±2.10.79
Corrected calcium (mg/dL)9.7±0.89.6±0.60.58
Phosphate (mg/dL)3.3±1.03.4±0.70.77
iPTH (pg/mL)267.0±297.3144.8±145.30.13

Baseline characteristics of patients whose data were included in the study

VariableOL-HDF (n = 32)PD (n = 37)KT (n = 42)P
Demographic data
Age (y)54.3±14.264.7±19.5

P < 0.05 in PD group when compared with OL-HDF and KT.

48.3±11.7<0.001
Male sex, n (%)11 (34.4)15 (40.5)20 (47.6)0.51
Body weight (kg)52.0 (18)53.3 (11)60.3 (21)0.32
Body mass index (kg/m2)20.5 (8)21.0 (5)22.3 (6)0.47
RRT duration (years)5.6 (6.7)3.5 (2.9)

P < 0.05 in PD group when compared with OL-HDF and KT.

4.7 (8.6)0.006
Presence of diabetes, n (%)12 (37.5)18 (48.6)7 (16.7)

P < 0.05 in KT group when compared with OL-HDF and PD.

0.009
Medications
RAS blockade (%)40.648.626.20.11
Erythropoietin (units/kg)209.8±206.3150.7±133.373.2±44.80.14
Cause of end stage renal disease
Diabetic nephropathy9 (28.1%)17 (45.9%)5 (11.9%)0.003
Glomerulonephritis6 (18.7%)6 (16.2%)18 (42.9%)0.01
Obstruction2 (6.3%)2 (5.4%)2 (4.8%)0.96
Polycystic kidney disease1 (3.1%)1 (2.7%)3 (7.1%)0.58
Hypertension10 (31.3%)5 (13.5%)1 (2.1%)0.002
Unknown4 (12.5%)6 (16.2%)13 (31.0%)0.11
Laboratory variables
25(OH)D (ng/mL)17.7±8.510.5±5.9

P < 0.05 in PD group when compared with OL-HDF and KT.

15.4±6.1<0.001
Hemoglobin (g/dL)10.9 (1.2)11.0 (1.6)11.9 (2.4)

P < 0.05 in KT group when compared with OL-HDF and PD.

0.003
Blood urea nitrogen (mg/dL)72.6±24.052.7±22.724.5±17.5

P < 0.05 in KT group when compared with OL-HDF and PD.

<0.001
Creatinine (mg/dL)10.3 (3.2)8.0 (6.3)1.2 (0.9)

P < 0.05 in KT group when compared with OL-HDF and PD.

<0.001
Uric acid (mg/dL)7.6 ± 1.5

P < 0.05 in OL-HDF group when compared with PD.

5.9±1.36.9 ± 2.30.001
Bicarbonate (mEq/L)24.1 ± 2.326.2 ± 3.0

P < 0.05 in PD group when compared with OL-HDF and KT.

23.7 ± 3.40.001
Corrected calcium (mg/dL)9.5 (1.2)9.5 (0.9)9.6 (1.0)0.68
Phosphate (mg/dL)4.9 (1.4)4.2 (1.4)3.3 (0.8)

P < 0.05 in KT group when compared with OL-HDF and PD.

<0.001
Total cholesterol (mg/dL)157.9 ± 30.9

P < 0.05 in OL-HDF group when compared with KT.

175.3 ± 45.5195.4±43.50.001
Triglyceride (mg/dL)98 (71.5)127.0 (149)117.5 (66.3)0.21
Low density lipoprotein (mg/dL)88.0 (30.3)84 (31.5)112.5 (55)0.05
High density lipoprotein (mg/dL)48.7±14.542.9±18.863.8 ± 21.7

P < 0.05 in KT group when compared with OL-HDF and PD.

<0.001
Intact parathyroid hormone (pg/mL)534.4 (496.8)288.8 (339.0)106.2 (231.4)

P < 0.05 in KT group when compared with OL-HDF and PD.

0.001
Albumin (g/dL)4.1 (0.8)3.6 (0.8)

P < 0.05 in PD group when compared with OL-HDF and KT.

4.2 (0.5)<0.001
Kt/V2.4 ± 0.42.2±0.5NA0.07
nPNA (g of N/kg/day)1.1 (0.4)1.0 (0.3)1.0 (0.4)0.10

Multiple logistic regression analysis of 25-hydroxyvitamin D (calcifediol) deficiency (<15 ng/mL) in 111 patients with renal replacement therapy

DeterminantsUnadjusted OR95% CIPAdjusted OR95% CIP
Treatment with RAS blockade5.152.01, 13.160.0017.452.17, 25.620.001
Triglyceride (mg/dL)

OR per 10 mg/dL increase in serum triglyceride

1.081.02, 1.140.0091.081.01, 1.160.03
Uric acid (g/dL)0.750.59, 0.940.010.720.52, 0.990.04
iPTH (pg/mL)

OR per 10 pg/mL increase in serum iPTH

1.011.00, 1.020.041.021.00, 1.040.02
Phosphate (mg/dL)0.950.71, 1.260.720.570.36, 0.900.02
Calcium (mg/dL)0.890.55, 1.430.620.610.30, 1.230.17
Albumin (g/dL)

OR per 0.1 g/dL increase in serum albumin

0.940.88, 1.010.080.930.85, 1.020.11
Female gender1.760.81, 3.840.162.420.86, 6.820.10

Summary of studies of prevalence of 25(OH)D deficiency in various renal replacement therapy modalities

Authors (year)CountriesStudy designPopulation (n)Duration of RRT (months)Age (years)[25(OH)D] (ng/mL)Prevalence of low [25(OH)D] (ng/mL) %
Saabetal. [5]USAretrospectiveHD (131)66.5 [4–303]59.0 [25–90]16.9±8.5Deficient (<15) 51
(2007)Insufficient (<30) 92
Del Valle etal. [9]Argentinacross-sectionalHD (84)41.0±29.658.9±16.624.4 (5–79)Deficient (<15) 22.6
(2007)Insufficient (15–30) 53.5
Jean et al. [6]Francecross-sectionalHD (253)62±7466.7±1414.8±10.4Deficient (<10) 42
(2008)Insufficient (10–30) 47
Blairetal. [7]USAretrospective,HD (344)37.1±34.561.9±16.321.0±13.5Deficiency (<40) 92.4
(2008)multi-centered
Porter etal. [8]USAretrospectiveHD (96)68.4±55.252.5±14.614.7±6.0Deficient (<15) 56
(2013)Insufficient (16–30) 44
Alwakeeletal. [14]Saudicross-sectionalPD (27)27.5±18.546.0±21.016.1±8.2Deficient (<15) 59.2
(2014)ArabiaInsufficient (15–25) 29.6
Ewers etal. [16]Denmarkcross-sectionalKT (173)88.8 (39.6–152.4)53.4±11.7F21.6 (15–31)Deficient (<15) 29.0
(2008)M 18.2 (12–27)Insufficient (16–30) 51.0
Marcenetal. [17]SpainretrospectiveKT (509)113.0±76.045.4±14.520.0±10.6Deficient (<16) 38.3
(2009)Insufficient (16–30) 46.9
Kulshresthaetal. [18]USAcross-sectionalKT (74)51.2 (47.9–53.5)46.0±16.0MS 20.5 ±7.2Deficient (<16) 29.7
(2013)Without MS 24.8±11.1Insufficient (16–30) 51.4
Beiqueetal. [19]CanadaretrospectiveKT (331)80.4 (34.8–129.6)51.0 (41.5–60.2)31.3 (23.4–39.9)Deficient (<30) 45.3
(2013)
Clayton etal. [13]Australiacross-sectionalHD (120)29.5 (11.6–53.1)64.1 (53.1–74.7)20.0 (12.7–26.0)HD deficient (<20) 49
(2009)PD (31)20.6 (10.5–43.8)68.6 (58.1–72.1)13.6 (8.4–15.0)HD insufficient (20–30) 33
PD deficient 77
PD insufficient 19
Iguaceletal. [11]Spaincross-sectionalOL-HDF (33)27.5 (12.0–70.5)60.0±16.019 (13–27)Deficient (5–15) 51.0
(2010)HD (61) PD (21)11 (6–16) 9 (6–12)Insufficient (16–30) 42.0
Hannaetal. [10]Australiacross-sectionalHD (26)22 (2–166)63.6±15.121.5 (4.1–50.4)HD deficient (<10) 3.8
(2014)PD (30)17 (1–70)56.9±16.213.2 (5.0–33.2)HD insufficient (10–20) 30.8
PD deficient 33.3
Eyaletal. [15]Israelcross-sectionalHD (50)90.4±74.656.2±15.430.3±19.1HD deficient (<15) 10
(2013)23.5 ± 9.9HD insufficient (16–30) 52
KT (103)KT deficient 22.3
KT insufficient 52.4
The presentThailandcross-sectional,OL-HDF (32)72.6±57.455.5+16.817.7±8.5OL-HDF deficient (<15) 50
study 44retrospective,OL-HDF insufficient (15-30)
single-centerPD (37)10.5±5.9
PD deficient 82
PD insufficient 18
KT (42)15.4 ± 6.1
PD deficient 82 PD insufficient 18
KT insufficient 45
eISSN:
1875-855X
Sprache:
Englisch
Zeitrahmen der Veröffentlichung:
6 Hefte pro Jahr
Fachgebiete der Zeitschrift:
Medizin, Gesundheitsfachberufe, Vorklinische Medizin, Grundlagenmedizin, andere, Klinische Medizin
Zeitschrift RSS Feed