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ORIGINAL ARTICLE
Year : 2017  |  Volume : 17  |  Issue : 4  |  Page : 125-131

Association of vitamin D deficiency with renal anemia and erythropoietin hyporesponsiveness in hemodialysis patients


1 Department of Internal Medicine, Medical Research Institute, Faculty of Medicine, Alexandria University, Alexandria, Egypt
2 Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
3 Department of Chemical Pathology, Medical Research Institute, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Correspondence Address:
Dr. Yaser A Ammar
Department of Internal Medicine, Medical Research Institute, Alexandria University, Alexandria, 21561
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jesnt.jesnt_15_17

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Background Many maintenance hemodialysis (MHD) patients exhibit erythropoietin (EPO) hyporesponsiveness. An inverse association has been found between vitamin D levels and EPO requirements in patients with chronic kidney disease. Vitamin D supplementation may improve response to EPO by either suppression of the chronic inflammatory status, control of hyperparathyroidism, or direct stimulation of erythroid progenitors. Aim A prospective clinical study is needed to assess the potential therapeutic role of vitamin D supplementation on EPO resistance index (ERI) in MHD patients. Methods A total of 30 patients with anemia on MHD for more than 6 months were included. They were on standard anemia therapy with subcutaneous (SC) EPO 4000 U and intravenous iron sucrose 100 mg once or twice weekly. A total of 20 age- and sex-matched healthy individuals were included as controls. Baseline laboratory studies included complete blood picture, calculation of ERI [weekly EPO dose/body weight in kg/hemoglobin (Hb) level], serum iron, total iron-binding capacity, ferritin, hepcidin, calcium, phosphorus, alkaline phosphatase (ALP), intact parathyroid hormone, 25(OH) vitamin D (vitamin D3), C-reactive protein, and interleukin (IL)-6. The studies were repeated after 3 months of oral α-calcidol therapy (2 µg thrice weekly, with each dialysis session). Results Hb increased significantly from 8.34±0.9 to 9.48±0.9 g/dl (P=0.000), and ERI decreased significantly from 7.39±1.13 to 6.61±1.2 IU/kg/g/dl (P=0.000). Inflammatory markers (serum C-reactive protein, IL-6, ferritin, and hepcidin) decreased significantly (P=0.000 for all). Serum intact parathyroid hormone and ALP decreased significantly (P=0.007 and 0.000, respectively). At the start of the study, there was a significant positive correlation between ERI and serum ferritin (P=0.026), and a significant negative correlation between serum vitamin D3 level and ALP (P=0.004). At the end of the study, there was a significant negative correlation between serum vitamin D3 level and each of serum ferritin (P=0.005) and IL-6 (P=0.019). Conclusion A 3-month course of oral α-calcidol significantly ameliorates hyperparathyroidism and inflammatory markers, increases Hb, and decreases ERI in MHD patients.


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