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RMU

Uruguayan Medical Journal

ISSN: 1688-0390


Vol.30 - Nº 3 - Set. 2014

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Vitamin D deficiency associated with anemia in patients on chronic hemodialisis

SOLA L; LEYUN N; DIAZ SALVIA J.C.; GONZALEZ RODRIGUEZ S; SEHABIAGUE C; PARODI K; OLASCOAGA A; ALALLON W
Rev Med Urug 2014; 30: 157-163
Full text (spanish) |  Full text (spanish) (New windows, pdf) | Abstract

Abstract

Introduction: vitamin D deficiency (25VD) is very common.

Objective: to evaluate the prevalence of severe vitamin D deficiency of 25VD (DS-25VD) in chronic hemodialysis patients and its association with metabolic alterations.

Method: cross-sectional study of chronic hemodialysis patients. Age, sex, hospitalizations and erythropoietin doses were recorded. Calcium, phosphorus, hemoglobin, intact parathyroid hormone, ferritin, C-reactive protein (CRP), 25VD and erythropoietin resistance (doses/gram Hb) were measured. Considering DS-25VD lower than 10 ng/ml, anemia was defined when anemia as hemoglobin was lower than 10 g/dL or use of erythropoietin. It was considered to be high upon: ferritin greater than 500 ng/ml and C-reactive protein (CRP) greater than 5 mg/L. Risk of DS-25VD and anemia were estimated using the logistic regression model. Comparisons were made using square chi or t-test according to DS-25VD, considering p < 0.05 was meaningful.

Results: 65 out of 105 patients (61.9%) were male, ages were 69.8 ± 13.2 a?os; 33 of them (31.4%) were diabetic. Average 25VD was 13,0±7.5 ng/ml, <30 ng/ml in 103 (97%) and 42 (40.8%) had DS-25VD. The DS-25VD was associated with anemia (90.7% vs 75.8%) and moderate-severe anemia (76.7% vs 51.6%). Patients with DS-25VD had a greater resistance to erythropoietin (8.6 vs 5.8), ferritin (592 vs 455 ng/ml) and CRP (15.8 vs 7.6 mg/L). The DS-25VD increased with high CRP (OR: 4.59, IC95% 1.69-12.44) and it increased the risk of anemia (OR: 3.09, IC: 1.06-9.01), adjusted according to age, sex, diabetes and intact parathyroid hormone. Twenty seven patients who were hospitalized had a significantly lower Hb (10.2 ± 1.4 vs 11.2 ± 1.4) and 25VD (10.4 ± 3.8 vs 13.8 ± 8.2).

Conclusions: the DS-25VD is associated to anemia and a greater erythropoietin resistance in chronic hemodialysis patients. The mechanism could imply a greater inflammation (high CRP and ferritin).