Influence of secondary hyperparathyroidism in management anemia in patients on regular hemodialysis (original) (raw)
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Vitamin D deficiency in hemodialysis patients
Indian Journal of Endocrinology and Metabolism, 2012
Background: Vitamin D [(25(OH)D] deficiency and insufficiency is common in patients with chronic kidney disease (CKD). 25(OH)D has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Indian patients on dialysis. This study was undertaken to determine the vitamin D status of Indian CKD patients on hemodialysis. Materials and Methods: We included 45 patients on maintenance hemodialysis coming to Medanta, Medicity, Gurgaon. 25(OH) D levels were measured with radioimmunoassay (Diasorin) method and parathyroid hormone (PTH) was measured using electrochemiluminiscence immunoassay (ECLIA). Results: The mean age of patients was 55 ± 13 years. 32/45 (71%) were males. 23/45 (51%) were diabetics. The median duration of hemodialysis was 5.5 months (range 1-74 months). 33/45 (74%) patients were on thrice weekly hemodialysis. The mean level of vitamin D was 10.14 ± 8.7 ng/ml. Majority of the patients [43/45 (95.5%)] were either vitamin D deficient or had insufficient levels. 40/45 (88.9%) were vitamin D deficient (levels <20 ng/ml); of these, 29/40 (64.4%) had severe vitamin D deficiency (levels <10 ng/ml) and 3/45 (6.7%) had insufficient levels (20-30 ng/ml) of vitamin D. Only 2/45 (4.4%) patients had normal levels of vitamin D. 23/45 (51%) of patients were receiving calcitriol. The mean levels of serum calcium, phosphorus, alkaline phosphatase, and albumin were 8.8 ± 0.64 mg/dl, 5.0 ± 0.7 mg/dl, 126 ± 10.3 IU/l and 3.6 ± 0.62 g/dl, respectively. PTH levels ranged from 37 to 1066 pg/ml, and the median was 195.8 pg/ml. There was a weak correlation between 25(OH)D levels and weight, sex, hemoglobin, albumin, alkaline phosphatase, and presence of diabetes. There was, however, no correlation with duration of dialysis or PTH levels. Conclusion: Vitamin D deficiency and insufficiency are universal in our hemodialysis patients, with severe vitamin D deficiency in two-third of patients.
Nephro-Urology Monthly, 2017
Background: Secondary Hyperparathyroidism (sHPT) is an important feature of chronic renal failure and contributes to the development of renal osteodystrophy. This study was carried out to assess 25(OH)D status and its effect on sHPT in patients on hemodialysis (HD). Methods: A prospective experimental trial of 180 HD patients (F: 81, M: 99, age > 14year) participated in the study. At base line, levels of 25(OH)D, intact Parathyroid Hormone (iPTH), Calcium (Ca), Phosphorous (P), Alkaline phosphatase (Alk p), and albumin of serum were measured. Patients with 25(OH)D deficiency (< 30 ng/mL) were randomly divided to two groups: intervention (received 300,000 U/IM vitD3 at the beginning and after 2 months, if was necessary) and control (received placebo). After 2 and 4 months, the same biochemical markers were measured and efficacy of vitD3 on sHPT was assessed. Secondary Hyperthyroidism (sHPT) was defined as iPTH > 300 pg/mL. Results: Serum 25(OH)D levels were deficient in 87.8% (n: 158) of subjects, and normal in 12.2% (n: 22). The prevalence of sHPT, according to 25(OH)D levels, was 71.5% (n: 113)(< 30 ng/mL) and 40.9% (n: 9)(≥ 30), respectively. There were 57 intervention and 56 control subjects. In the intervention group, 2 months after injections, 25(OH)D increased from 13.85 ± 6.5 to 48.5 ± 20.7 (P < 0.001), iPTH was reduced from 567.2 ± 276.7 to 282.7 ± 183.6 (P < 0.001), calcium from 9.10 ± 0.5 to 8.76 ± 0.7 (P = 0.021), Alk p from 553.37 ± 495.6 to 393.4 ± 419.5 (P < 0.001), albumin from 3.87 ± 0.5 to 4.00 ± 0.4 (P = 0.06), and phosphorus from 4.90 ± 1.2 to 5.21 ± 1.3 (P = 0.12). Since all cases were under appropriate treatment for sHPT, there was a significant reduction on the levels of iPTH (P = 0.005) and Alk p (P = 0.049), and slight increase in 25(OH)D level (P = 0.08) in the control group. However, the amount of these changes was less than the intervention group. Conclusions: These findings showed that 25(OH)D insufficiency was highly prevalent in HD cases and higher amount of 25(OH)D levels prevent sHPT.
Factors Affecting Nutritional Vitamin D Level in Patients on Maintenance Hemodialysis
Pakistan postgraduate medical institute, 2022
Objective: To determine which factors are affecting nutritional vitamin D levels in patients on maintenance hemodialysis. Methods: It is a Cross sectional descriptive study conducted at DHQ hospital, Sheikhupura. All patients on maintenance hemodialysis for more than one month were included in this study. Patients with acute kidney injury and less than one month on hemodialysis were excluded from the study. Performa was designed for demographic (age, gender, education and address) and laboratory data (hemoglobin, urea, creatinine, albumin, bicarbonate, calcium, phosphate, intact parathyroid-PTH, vitamin D) of all the patients. Results: One hundred and forty-six patients were enrolled in the study. Eighty-six (58.9%) were from more than fiftyyears of age. Fifty-eight (39.7%) reported diabetes mellitus and Hypertension was the cause of End Stage Renal Disease (ESRD). All patients were on twice weekly dialysis. One hundred and ninety (81.5%) were started via double lumen catheter, sixty-nine (47.3%) had more than hundred total number of dialysis, one hundred and seven (73.3%) had need of transfusion. There was significant association observed of vitamin D3 levels with age, total number of dialysis and blood transfusions required. Vitamin D3 had significantly associated with intact parathyroid (iPTH) levels and albumin, 55.8% sample found with less than ten vitamin D3 level and iPTH between 100-600, whereas 88.4% sample found with less than four albumin levels (p-value < 0.05). Conclusions: Vitamin D levels can be used as nutritional tool in dialysis patients. Age, albumin, PTH, total number of dialysis and blood transfusion had significant association with vitamin D level.
Association of vitamin D deficiency and hyperparathyroidism with anemia: a cross-sectional study
Journal of Blood Medicine, 2013
Vitamin D deficiency and anemia are common in the Middle East, and vitamin D deficiency and hyperparathyroidism have been reported to be associated with an increased prevalence of anemia. In this study, the hypothesis that vitamin D deficiency and hyperparathyroidism may be associated with anemia in a Bahraini population was tested. Association of hyperparathyroidism and vitamin D levels (deficiency and insufficiency) with anemia was investigated in 421 Bahrainis (213 males and 208 females). In females, the prevalence of anemia was significantly associated with vitamin D deficiency independent of parathyroid hormone levels (odds ratio: 2.9; 95% confidence interval: 2.3-10.5; P = 0.001). In females, the prevalence of anemia appeared to be significantly associated with hyperparathyroidism (odds ratio: 2.1; 95% confidence interval: 1.2-3.7; P = 0.01); however, this significant association disappeared when adjusted for vitamin D deficiency (odds ratio: 1.6; 95% confidence interval: 0.75-6.5; P = 0.154). Results from this study suggest that vitamin D deficiency is independently associated with anemia in females but not males. Further studies to determine whether vitamin D supplementation could be used to treat anemia are warranted.
Hemodialysis International, 2010
Secondary hyperparathyroidism (SHPT) is a frequent complication in chronic kidney disease, especially in hemodialysis (HD) patients. Treatments for SHPT include calcitriol analogues (CA), phosphate binders, cinacalcet (CC), and surgical parathyroidectomy (PTX). This study aimed to assess the incidence and prevalence of SHPT in a single center during the period when native vitamin D (N-VitD) supplementation and CC treatment became available. All incident and prevalent HD patients were prospectively recorded and compared using 3 periods from 2004 to 2005 (period 1), 2006 to 2007 (period 2), and 2008 to 2009 (period 3). SHPT was diagnosed with serum parathyroid hormone (PTH) levels 4300 pg/mL or the need for CA, CC, or PTX. Between periods 1 and 3, in incident patients (n= 120 and 101), N-VitD prescription increased from 11% to 68% (Po0.0001), CA prescription remained stable (40%), and patients with PTH4300 pg/mL decreased from 40% to 12% (Po0.0001). In prevalent HD patients (n= 235), N-VitD treatment increased from 55% to 91% (Po0.0001), whereas treatment with CA decreased from 67% to 17% (Po0.0001). Patients with serum PTH4300 pg/mL decreased from 38% to 13% (Po0.001), whereas patients with PTHo150 pg/mL remained stable (o30%). New CC prescriptions decreased from 45 to 3 (Po0.0001). Since 2004, SHPT has decreased drastically in incident and prevalent HD patients. The preventive role of N-VitD supplementation appears to be obvious and represents one more argument for its general recommendation in CKD patients.
JN. Journal of Nephrology (Milano. 1992)
We sought to examine the impact of ergocalciferol (ERGO) on recombinant human erythropoietin (EPO) use in a cohort of 25-OH vitamin D (25-D)-deficient hemodialysis (HD) patients. Baseline 25-D levels were obtained for all patients who received HD >6 months in our unit. Patients with levels between 10 and 30 ng/mL received ERGO 50,000 IU x 4 doses and patients with levels <10 ng/mL received 50,000 IU x 6 doses over a 4-month period. Monthly dose of EPO was recorded at baseline and after ERGO supplementation. Baseline 25-D levels were <30 ng/mL in 89% of tested patients. Eighty-one patients were included in this study. Mean baseline 25-D level was 15.3 ± 7.1 ng/mL and increased to 28.5 ± 8.6 ng/mL after ERGO (p<0.0001), and median baseline EPO dose was 21,933 U/month (interquartile range [IQR] 13,867-35,967) and decreased to 18,400 U/month (IQR 11,050-33,000) after ERGO (p=0.17). Forty-six patients (57%) required less EPO after ERGO compared with baseline: 15,450 U/month (...
Vitamin D levels and early mortality among incident hemodialysis patients
Kidney International, 2007
Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case-control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.
Pakistan Journal of Kidney Diseases, 2021
Objective The objective of this study was to assess the relationship between intact parathyroid hormone levels (iPTH) and hemoglobin (Hb) levels in patients with end-stage renal disease (ESRD) who were on hemodialysis. Material and methods An observational, cross-sectional study was conducted in the Department of Nephrology at Jinnah Postgraduate Medical Centre in Karachi, Pakistan. Patients were enrolled in this study after consent and institutional review board approval. Serum samples were collected for Hb level, iPTH level, vitamin D, urea and creatinine, ferritin, and transferrin saturation. Results Ninety four patients were inducted into this study; men comprised 66.0% of the patients, and Diabetes mellitus was the commonest etiology of ESRD. Most of the patients were on dialysis for more than 5 years on twice per week hemodialysis. Mean Hemoglobin was 9.29g/dl, iPTH 576.59ng/dl and Vitamin D 25.47ng/ml. Significant inverse correlation was found between anemia and i-PTH level...
Research, Society and Development
Chronic Kidney Disease (CKD) is an injury that causes progressive impairment of exocrine and endocrine renal functions. A very common complication is anemia, caused by reduced erythropoietin production, iron deficiency and inflammation. Evidence demonstrates that vitamin D has effects on anemia of inflammation, through the increase in erythrocytes and decrease in pro-inflammatory cytokines. This study aims to review the effects of vitamin D supplementation on 25(OH)D2 concentrations, on anemia markers and on PTH levels. This is an integrative review carried out through the search and selection of original publications, in english and portuguese, indexed in PubMed, Web of Science and Science Direct databases belonging to the 2010-2020 range. The results pointed to 25(OH)D2 concentrations compatible with normality after vitamin D supplementation. In five studies, there was no change in hemoglobin and PTH levels, and in four studies there was a reduction in the dose of EPO or erythroid...
BMJ, 1981
differences in gastric emptying to variability in plasma propranolol concentrations. Br J Clin Pharmacol 1978 ;5:121-2. Vestal RE, Wood AJJ, Branch RA, Shand DG, Wilkinson GR. Effects of age and cigarette smoking on propranolol disposition. Clin Pharmacol Ther 1979;26:8-15. 12 Wood AJJ, Kornhauser DM, Wilkinson GR, Shand DG, Branch RA. The influence of cirrhosis on steady-state blood concentrations of unbound propranolol after oral administration. Clin Pharmacokinet 1978;3 :478-87. 13 Lowenthal DT, Briggs WA, Gibson TP, Nelson H, Cirksena WJ. Pharmacokinetics of oral propranolol in chronic renal disease. Clin Pharmacol Ther 1974;16:761-9. 14 Feely J, Stevenson IH. The effect of age and hyperthyroidism on plasma propranolol steady state concentration. Br Y Clin Pharmacol 1978;6: 446P. 15 Cotham RH, Shand DG. Spuriously low plasma propranolol concentrations resulting from blood collection methods. Clin Pharmacol Ther 1975 ;18:535-8. 16 Wood M, Shand DG, Wood AJJ. Altered drug binding due to the use of indwelling heparinized cannulas (heparin lock) for sampling. Clin Abstract