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Luo C, Bian X, Bao L, Xu Q, Ji C. Association between serum 25-hydroxyvitamin D level and inflammatory markers in hemodialysis-treated patients. Immun Inflamm Dis 2024; 12:e1201. [PMID: 38652006 PMCID: PMC11037256 DOI: 10.1002/iid3.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE To investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) level with novel inflammatory markers in hemodialysis-treated patients. METHODS A total of 167 maintenance hemodialysis-treated patients were enrolled in this cross-sectional study. The patients were divided into vitamin D deficiency (a serum 25(OH)D level <20 ng/mL) and nondeficiency (a serum 25(OH)D level ≥20 ng/mL) groups. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) were calculated by the complete blood cell count. The relationship between 25(OH)D level with other parameters was assessed by bivariate correlation analysis and linear regression analysis. RESULTS There were significant differences between the two groups in terms of age, diabetes, levels of albumin, creatinine, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) as well as NLR and MLR (p = .004, p = .031, p < .001, p = .043, p = .008, p = .006, p = .002, and p < .001, respectively). There exist negative correlations between serum 25(OH)D level with age, diabetes, alkaline phosphatase level, NLR, PLR, and MLR (p = .002, p = .002, p = .037, p = .001, p = .041, and p < .001, respectively) and positive correlations between serum 25(OH)D level with albumin level, creatinine level, phosphorus level, HDL-C, and LDL-C (p < .001, p < .001, p = .013, p = .02, p = .002, respectively). Multiple analysis results showed that sex, diabetes, albumin level and NLR were independently associated with serum 25(OH)D level (p = .021, p = .015, p = .033, and p = .041, respectively). High values of NLR and MLR were associated with patients with serum 25(OH)D deficiency. There were negative interplays between serum 25(OH) D level with NLR, PLR, and MLR and also an independent association between serum 25(OH) D level with NLR. CONCLUSION Collectively, serum 25(OH)D level has a negative correlation with inflammatory markers.
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Affiliation(s)
- Chunlei Luo
- Department of NephrologyThe First Affiliated Hospital of Ningbo UniversityNingboZhejiangChina
| | - Xueyan Bian
- Department of NephrologyThe First Affiliated Hospital of Ningbo UniversityNingboZhejiangChina
| | - Lingling Bao
- Department of NephrologyThe First Affiliated Hospital of Ningbo UniversityNingboZhejiangChina
| | - Qingqing Xu
- Department of NephrologyThe First Affiliated Hospital of Ningbo UniversityNingboZhejiangChina
| | - Chunyang Ji
- Department of NephrologyThe First Affiliated Hospital of Ningbo UniversityNingboZhejiangChina
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Lee JH, Seo JD, Lee K, Roh EY, Yun YM, Lee YW, Cho SE, Song J. Multicenter comparison of analytical interferences of 25-OH vitamin D immunoassay and mass spectrometry methods by endogenous interferents and cross-reactivity with 3-epi-25-OH-vitamin D 3. Pract Lab Med 2024; 38:e00347. [PMID: 38188654 PMCID: PMC10770599 DOI: 10.1016/j.plabm.2023.e00347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Vitamin D (vit-D) deficiency is highly prevalent in the Korean population, highlighting the need for accurate measurements. In this study, the interferences by endogenous and cross-reactive substances were compared between routine vit-D immunoassays and mass spectrometry (MS) methods. Methods Two MS methods and 4 immunoassays from different manufacturers (Abbott, Beckman Coulter, Roche, Siemens) were compared. Residual samples that were icteric, lipemic, hemolyzed, high in rheumatoid factor, from myeloma patients, or patients undergoing hemodialysis were collected. Also, 4 levels of National Institute of Standards and Technology (NIST) Standard Reference Material 972a, and 12 samples serially spiked with 3-epi-25-OH-D3 were prepared. Results Significant interferences were observed in hemolytic (Roche), icteric (Beckman and Siemens) and lipemic samples (all 4 immunoassays). Level 4 NIST material and 3-epi-25-OH-D3-spiked samples induced significant cross-reactivity, yielding higher total vit-D measurements in non-epimer-separating MS methods, and both the Beckman and Roche immunoassays. Conclusion Most observed interferences were consistent with manufacturers' claims, but overall improvement of immunoassay bias limits is required. Awareness of potential interference is important to increase the accuracy of vit-D measurements. Moreover, care is due when interpreting vit-D results of newborns, infants and less commonly, pregnant women, who are known to have physiologically high levels of the highly cross-reactive 3-epi-25-OH-D3.
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Affiliation(s)
- Joon Hee Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jong Do Seo
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Kyunghoon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Laboratory Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Yong-Wha Lee
- Department of Laboratory Medicine & Genetics, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Sung-Eun Cho
- Department of Endocrine Substance Analysis Center (ESAC), Green Cross Laboratories (GC Labs), Yongin, South Korea
| | - Junghan Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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AbdElHady MS, Ibrahim ST, Adam A, Elnekidy A, Lewis N, Gawesh RI. DO VITAMIN D DEFICIENCY AND HEPATITIS C VIRUS INFECTION PLAY A ROLE IN OXIDATIVE STRESS IN PATIENTS ON MAINTENANCE HEMODIALYSIS? ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1956831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Mahmoud S. AbdElHady
- Department of Internal Medicine and Nephrology Department, Kafr ELSheikh University, Egypt
| | - Sara T Ibrahim
- Department of Internal Medicine and Nephrology Department, Faculty of Medicine, Alexandria University, Alexandria Egypt
| | - Ahmed Adam
- Department of Internal Medicine and Nephrology Department, Faculty of Medicine, Alexandria University, Alexandria Egypt
| | - Abelaziz Elnekidy
- Department of Radiodiagnosis Faculty of Medicine Alexandria University, Egypt
| | - Neveen Lewis
- Department of Clinical Pathology Department, Alexandria University Hospital, Egypt
| | - Rasha Ibrahim Gawesh
- Department of Internal Medicine and Nephrology Department, Faculty of Medicine, Alexandria University, Alexandria Egypt
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Ali M, Ejaz A, Solangi SA, Junejo AM, Yaseen M, Iram H, Solangi SA. Vitamin D Deficiency in End Stage Renal Disease Patients with Diabetes Mellitus Undergoing Hemodialysis. Cureus 2020; 12:e11668. [PMID: 33391906 PMCID: PMC7769723 DOI: 10.7759/cureus.11668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: To assess the association of hypovitaminosis D with diabetes mellitus (DM) in patients with end stage renal disease (ESRD) undergoing hemodialysis. Methodology: This cross-sectional study was conducted at the Jinnah Postgraduate Medical Centre between July 2019 and February 2020. Patients with diagnosed ESRD who were on hemodialysis, with or without concomitant DM were registered. Vitamin D levels were categorized according to the severity of the deficiency or excess as 0-10 ng/mL, severely deficient; 11-20 ng/mL, deficient; 21-32 ng/mL; insufficient, 33-49 ng/mL, adequate; 50-65 ng/mL, optimum; and above that as high. Patients were stratified according to the status of DM. Results: In a total of 80, the mean age was 45.21±12.67 years with 51 (63.75%) males and 29 (36.25%) females. A total of 36 (45%) CKD patients had concomitant diabetes. The median vitamin D levels were 20.25ng/mL. It was found that chronic kidney disease (CKD) patients with concomitant DM had significantly lower levels of vitamin D [15.19±6.83 vs. 30.28±14.22 (p<0.001)]. Out of the 12 patients with a severe deficiency, three-fourths of the population had DM as comorbidity, while in those with ‘deficiency’, 19 (67.9%) had DM. The majority of the patients without DM had adequate or optimum levels of serum 25-hydroxyvitamin D levels. Conclusion: Current study indicated that deficiency of serum vitamin D is associated with concomitant DM in patients with CKD as the majority had a severe deficiency of serum 25(OH)D. Supplemental vitamin D may help correct the deficiency and prevent the associated complications in patients.
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Affiliation(s)
- Muhammad Ali
- Nephrology, Fazaia Ruth Pfau Medical College, Karachi, PAK
| | - Ayesha Ejaz
- Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | | | | | - Hina Iram
- Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Treatment of secondary hyperparathyroidism with paricalcitol in patients with end-stage renal disease undergoing hemodialysis in Turkey: an observational study. Int Urol Nephrol 2019; 51:1261-1270. [DOI: 10.1007/s11255-019-02175-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/14/2019] [Indexed: 12/29/2022]
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Effects of Inactive Vitamin D on Persistent Secondary Hyperparathyroidism in Patients on Hemodialysis. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.45029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vikrant S, Parashar A. Prevalence and severity of disordered mineral metabolism in patients with chronic kidney disease: A study from a tertiary care hospital in India. Indian J Endocrinol Metab 2016; 20:460-467. [PMID: 27366711 PMCID: PMC4911834 DOI: 10.4103/2230-8210.183457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Disordered mineral metabolism is common complications of chronic kidney disease (CKD). However, there are limited data on the pattern of these disturbances in Indian CKD population. MATERIALS AND METHODS This was a prospective observational study of CKD-mineral and bone disorder (CKD-MBD) over a period of 3 years. The biochemical markers of CKD-MBD, namely, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), and 25-hydoxyvitamin Vitamin D3 (25OHD), were measured in newly diagnosed CKD Stage 3-5 and prevalent CKD Stage 5D adult patients. RESULTS A total of 462 patients of CKD Stage 3-5D were studied. The frequency of various biochemical abnormalities was hypocalcemia (23.8%), hypercalcemia (5.4%), hypophosphatemia (2.8%), hyperphosphatemia (55.4%), raised alkaline phosphatase (56.9%), secondary hyperparathyroidism (82.7%), and hypoparathyroidism (1.5%). 25OHD was done in 335 (72.5%) patients and 90.4% were found to have Vitamin D deficiency. About 70.6% of the patients had iPTH levels were above kidney disease outcomes quality initiative (KDOQI) target range. Nondiabetic CKD as compared to diabetic CKD had a higher alkaline phosphatase (P = 0.016), a higher iPTH (P = 0.001) a higher proportion of patients with iPTH above KDOQI target range (P = 0.09), and an elevated alkaline phosphatase (P = 0.004). The 25OHD levels were suggestive of severe Vitamin D deficiency in 33.7%, Vitamin D deficiency in 45.4%, and Vitamin D insufficiency in 11.3% patients. There was a significant positive correlation between iPTH with alkaline phosphatase (r = 0.572, P = 0.001), creatinine (r = 0.424, P = 0.001), and phosphorus (r = 0.241, P = 0.001) and a significant negative correlation with hemoglobin (r = -0.325, 0.001), age (r = -0.169, P = 0.002), and 25OHD (r = -0.126, P = 0.021). On multivariate logistic regression analysis, an elevated alkaline phosphatase was a significant predictor of hyperparathyroidism (odds ratio 9.7, 95% confidence interval 4.9-19.2, P = 0.001). CONCLUSIONS There was a high prevalence of CKD-MBD in Indian CKD patients. CKD-MBD is more common and more severe and has an early onset as compared to the western populations.
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Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Parashar
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Wang F, Wu S, Ruan Y, Wang L. Correlation of serum 25-hydroxyvitamin D level with vascular calcification in hemodialysis patients. Int J Clin Exp Med 2015; 8:15745-15751. [PMID: 26629071 PMCID: PMC4658960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the correlation of serum 25-hydroxyvitamin D level with vascular calcification in patients treated with hemodialysis. METHODS As a cross-sectional study, 126 patients receiving maintenance hemodialysis (MHD) in our hospital were enrolled in this study. According to the serum 25-hydroxyvitamin D level, the patients were divided into 25-hydroxyvitamin D deficiency group (30 ηg/ml or less than 30 ηg/ml) and 25-hydroxyvitamin D normal level group (>30 ηg/ml). All of the subjects underwent lateral lumbar, pelvis and hands X-ray examination to score the degree of calcification (Kauppila score). RESULTS Among the 126 patients treated with MHD, there were 110 patients with 25-hydroxyvitamin D deficiency and 16 patients with normal 25-hydroxyvitamin D level. There was no significant difference found in gender, age, age of dialysis, active vitamin D treatment, blood calcium, blood phosphorus, blood parathyroid hormone (PTH) and other related indicators between the two groups. The incidence of vascular calcification in patients with 25-hydroxyvitamin D deficiency was significantly higher than that in patients with normal 25-hydroxyvitamin D level (P = 0.001). Serum 25-hydroxyvitamin D level had a negative correlation with the calcification score (r = 0.193, P = 0.193). Logistic regression showed that 25-hydroxyvitamin D was not a risk factor for vascular calcification in MHD patients. Serum 25-hydroxyvitamin D level is generally low in patients with MHD. CONCLUSIONS Patients with 25-hydroxyvitamin D deficiency have a higher incidence of vascular calcification with a markedly negative correlation. Thus, for the patients treated with MHD, vitamin D deficiency should be actively treated.
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Affiliation(s)
- Fang Wang
- Department of Urology, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital Chengdu 610072, China
| | - Shukun Wu
- Department of Urology, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital Chengdu 610072, China
| | - Yizhe Ruan
- Department of Urology, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital Chengdu 610072, China
| | - Li Wang
- Department of Urology, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital Chengdu 610072, China
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Vitamin D deficiency--prognostic marker or mortality risk factor in end stage renal disease patients with diabetes mellitus treated with hemodialysis--a prospective multicenter study. PLoS One 2015; 10:e0126586. [PMID: 25965403 PMCID: PMC4428845 DOI: 10.1371/journal.pone.0126586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/06/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) patients on renal replacement therapy (RRT) with diabetes mellitus (DM) have a higher mortality rate and an increase prevalence of vitamin D deficiency compared to those without DM. It is still debated if vitamin D deficiency is a risk factor or a prognostic marker for mortality in these patients. This study investigated the prevalence of vitamin D deficiency and its impact on all-cause mortality in HD patients with DM. METHODS Our prospective non-interventional cohort study included 600 patients on hemodialysis therapy (HD) (median aged 56, interquartile range (19) years, 332 (55.3%) males) recruited from 7 HD centers, from all main geographical regions of Romania. The prevalence of DM was 15.3%. They were then followed regarding: dialysis duration, dialysis efficiency, renal anemia, CKD-MBD, inflammatory status and comorbidities: coronary artery disease (CAD), peripheral vascular disease (PVD) and stroke. The deficiency of 25-OH vitamin D was defined as a value lower than 12 ng/mL. RESULTS Patients were followed for 3 years. The overall 3 year mortality was 25.5% (153 individuals), being higher in patients with DM as compared to those without DM (33.7% vs. 24.0%; P = 0.049). The time-related prognosis was also influenced by the presence of DM, at the survival analysis resulting in a HR of 1.52 [1.03 to 2.26] 95% CI, P = 0.037, for death in dialyzed patients with DM. In DM patients, 25-OH vitamin D deficiency was significantly higher (37.0% compared to 24.0%, P = 0.009). Furthermore, in patients with DM we observed a shorter dialysis duration (2 vs. 3 years, P<0.001) and a lower intact parathyroid hormone (iPTH) (258.0 pg/ml vs. 441.9 pg/ml, P = 0.002). Regarding the presence of comorbidities at the inclusion in the study, the presence of diabetes in dialyzed patients was associated with increased prevalence of CAD (87.0% vs. 58.1%, P<0.001), PVD (67.4% vs. 17.3%, P<0.001) and history of stroke (29.3% vs. 14.0%, P<0.001). In patients with DM the presence of 25-OH vitamin D deficiency increased the probability of death (50.0% vs. 24.1%; P = 0.011). In multiple Cox proportional hazards analysis, vitamin D deficiency remained an independent predictor for mortality in dialysis patients with DM (HR = 1.71, 95% CI 1.21 to 2.43, P = 0.003). In the same time, multiple Cox proportional hazards analysis showed that age (HR = 1.02 per one year increase, P = 0.004), CAD (HR = 1.55, P = 0.046) and PVD (HR = 1.50, P = 0.029) were independent predictors for mortality in dialysis patients with DM. CONCLUSIONS ESRD patients with DM treated with HD have a higher overall mortality than non-DM patients. Vitamin D deficiency is significantly more prevalent in HD patients with DM. Low 25-OH vitamin D levels were associated with increased all-cause mortality in these patients. According to our data, in HD patients with DM, screening for vitamin D deficiency (and its correction) should be mandatory for an optimal risk reduction strategy.
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Wu S, Wang J, Wang F, Wang L. Oral active vitamin d treatment and mortality in maintenance hemodialysis patients. Cardiorenal Med 2014; 4:217-24. [PMID: 25737686 DOI: 10.1159/000368203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/02/2014] [Indexed: 12/17/2022] Open
Abstract
AIMS To analyze the relationship between oral active vitamin D treatment and mortality in maintenance hemodialysis (MHD) patients. METHODS We examined the association of oral calcitriol treatment with mortality in 156 MHD patients (80 men and 76 women; mean age: 59 ± 15 years). The survival analysis of all-cause and cardiovascular mortality was performed using the Kaplan-Meier survival and Cox proportional-hazards analyses. RESULTS In all, 108 of the 156 patients received active vitamin D treatment. The intact parathyroid hormone level was obviously lower in the patients who received active vitamin D treatment than in those who did not. Throughout the whole follow-up, overall mortality was 16.7% (26 deaths, 13 in each group). The cardiovascular mortality rates were 14.6% (8/48) in the control group and 4.6% (5/108) in the calcitriol group. The crude analysis of all-cause and cardiovascular mortality using the Kaplan-Meier curve showed a significant reduction in mortality risk for patients who received oral active vitamin D compared with those who did not receive it (p = 0.015 and 0.026, respectively). Cox's regression analysis showed that active vitamin D treatment was associated with a significantly lower risk of all-cause mortality (RR = 0.399, 95% CI 0.185-0.862, p = 0.019) and cardiovascular mortality (RR = 0.295, 95% CI 0.094-0.93, p = 0.037). However, after adjusting for potential confounding variables, oral active vitamin D therapy was no longer clearly associated with a lower risk of either all-cause or cardiovascular mortality. CONCLUSION Oral active vitamin D treatment was associated with improved survival in MHD patients. However, this survival benefit was smaller than previously reported, and a large cohort study should be performed.
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Affiliation(s)
- Shukun Wu
- Department of Nephrology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, PR China
| | - Junru Wang
- Department of Nephrology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, PR China
| | - Fang Wang
- Department of Nephrology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, PR China
| | - Li Wang
- Department of Nephrology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, PR China
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Shapiro BB, Streja E, Chen JLT, Kovesdy CP, Kalantar-Zadeh K, Rhee CM. The relationship between ultraviolet light exposure and mortality in dialysis patients. Am J Nephrol 2014; 40:224-32. [PMID: 25322752 DOI: 10.1159/000367903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/25/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Emerging data suggest that reduced exposure to ultraviolet (UV) radiation is associated with increased mortality in the general population. To date, the association between UV exposure and mortality in dialysis patients has not been examined. METHODS We examined the association between UV index, a proxy of UV exposure, and all-cause mortality among 47,286 US dialysis patients (entry period 2001-2006, with follow-up through 2009) from a large national dialysis organization using multivariable Cox regression. The UV index was ascertained by linking individual patients' residential zip codes to National Oceanic and Atmospheric Administration data, and was categorized as low (0-<3), moderate (3-<5), moderate-high (5-<6), high (6-<7), and very-high (≥7). In secondary analyses, we examined the UV index-mortality association within subgroups of age (<65 vs. ≥65 years old), sex, and race (white vs. non-white). RESULTS The study population's mean ± SD age was 60 ± 16 and included 46% women and 56% diabetics. Compared to patients residing in moderate-high UV index regions, those residing in high and very-high UV index regions had a lower mortality risk: adjusted HRs 0.84 (95% CI) 0.81-0.88 and 0.83 (95% CI) 0.75-0.91, respectively. A similar inverse association between UV index and mortality was observed across all subgroups, although there was more pronounced reduction in mortality among whites vs. non-whites. CONCLUSION These data suggest that dialysis patients residing in higher UV index regions have lower all-cause mortality compared to those living in moderate-high UV regions. Further studies are needed to determine the mechanisms underlying the UV index-mortality association.
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Affiliation(s)
- Bryan B Shapiro
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, Calif., USA
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Bansal B, Bansal SB, Mithal A, Kher V, Marwaha R, Singh P, Irfan N. A randomized controlled trial of cholecalciferol supplementation in patients on maintenance hemodialysis. Indian J Endocrinol Metab 2014; 18:655-661. [PMID: 25285282 PMCID: PMC4171888 DOI: 10.4103/2230-8210.139227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is common in Indian patients with chronic kidney disease (CKD) on maintenance hemodialysis (MHD), but optimal dose of cholecalciferol is unclear. MATERIALS AND METHODS A total of 45 consenting patients were randomized to intervention and control groups. In the intervention group, patients (n = 35) with serum 25-hydroxy vitamin D (25(OH)D) < 30 ng/mL (n = 33), received oral cholecalciferol 60,000 units/week for 6 weeks. The serum levels of 25(OH)D, calcium, phosphorus, albumin, and parathyroid hormone (PTH) were measured at 0, 6, and 12 weeks. In the control group (n = 10), these were estimated at 0 and 6 weeks. RESULTS In the intervention group, 25/35 patients completed the supplementation at 6 weeks and 20/35 were available at 12 weeks. The mean baseline level of 25(OH)D was 9.59 ± 7.59 ng/mL, and after 6 weeks 19.51 ± 4.27 ng/mL, mean increase being 9.99 ± 6.83 ng/mL, which was highly significant (P < 0.0001). After discontinuing supplementation at 6 weeks, serum 25(OH)D level dropped significantly from 6 to 12 weeks [-2.84 ± 6.25 ng/mL (P = 0.04)]. However, it was still significantly higher at 12 weeks (16.08 ± 8.27 ng/mL) as compared with the baseline. PTH and calcium did not change significantly with supplementation. The change in serum 25(OH)D level from baseline to 6 weeks in the intervention group was inversely related to baseline 25(OH)D levels and patient's weight. In the control group, change in 25(OH)D from baseline to 6 weeks was not significant. CONCLUSION Supplementation with cholecalciferol 60,000 unit/week for 6 weeks was insufficient to achieve optimal levels of 25(OH)D in Indian patients with CKD on MHD.
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Affiliation(s)
- Beena Bansal
- Senior Consultant, Division of Endocrinology and Diabetes, Kidney and Urology Institute, Gurgaon, Haryana, India
| | | | - Ambrish Mithal
- Chairman, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Vijay Kher
- Chairman, Kidney and Urology Institute, Gurgaon, Haryana, India
| | - R. Marwaha
- Scientific Advisor, Institute of Life Sciences, Gurgaon, Haryana, India
| | - Padam Singh
- Chief Statistical Advisor, Medanta Institute of Education and Research, Gurgaon, Haryana, India
| | - Nasir Irfan
- Medical Officer, Chenab Hospital, Dulhasti Power Station, National Hydel Power Corporation Ltd., Kishtwar, Jammu and Kashmir, India
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Gannagé-Yared MH, Farès C, Ibrahim T, Rahal ZA, Elias M, Chelala D. Comparison between a second and a third generation parathyroid hormone assay in hemodialysis patients. Metabolism 2013; 62:1416-22. [PMID: 23769129 DOI: 10.1016/j.metabol.2013.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/15/2013] [Accepted: 05/08/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Third generation parathyroid hormone (PTH) assays are new generation assays that do not recognize the PTH7-84 fragment whereas second generation assays detect both PTH1-84 and PTH7-84 fragments. Despite the excellent correlation between both assays in chronic renal failure (CRF) subjects, the mean PTH levels are typically 50% lower with the third compared to the second generation assays. The assessment of third generation PTH assays has not been extensively studied in hemodialysis subjects. The purpose of our study was to compare a third generation PTH assay to a second generation one in a population of hemodialysis subjects. MATERIALS AND METHODS 92 haemodialysis subjects (36 women and 56 men) with a mean age of 67±12.9 years were included in this study. Anthropometric and clinical parameters (Body Mass Index (BMI) and blood pressure) were measured. Second and third generation PTH assays (Cis biomedical and Diasorin respectively) were performed in each subject. In addition, the following biochemical tests were measured: 25-hydroxyvitamin D (25-(OH)D), 1,25-hydroxyvitamin D (1,25-(OH)2D), crosslaps and alkaline phosphatase. RESULTS The mean second and third generation PTHs are respectively 211±205 pg/ml and 151±164 pg/ml. The mean third generation PTH values are 28.4% lower compared to the second generation ones. Both methods are strongly correlated (r=0.923, p<0.001). This correlation persisted without any significant difference after controlling for gender, age, BMI and Blood Pressure. However, the difference between both methods increases when baseline PTH increases. Each of the second and third generation method is significantly correlated with hemodialysis duration (p<0.01), crosslaps (p<0.001), alkaline phosphatase (p<0.05), but not with age, BMI, Blood Pressure, 25-(OH)D or 1,25-(OH) 2D levels. CONCLUSION Our results show that both second and third generation PTH methods are strongly correlated in hemodialysis patients mainly when PTH values are low. However, the difference between both methods increases when PTH values are high. More research is needed to establish which method is the gold standard when PTH values are high.
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Joob B, Wiwanitkit V. Vitamin D deficiency in hemodialysis. Indian J Endocrinol Metab 2012; 16:866-867. [PMID: 23087893 PMCID: PMC3475933 DOI: 10.4103/2230-8210.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Beuy Joob
- Sanitation 1 Medical Academic Center, Bangkok, Thailand
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