Journal of The Egyptian Society of Nephrology and Transplantation

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


Yaser A Ammar1, Yaser A Nienaa2, Salah S El-Banawy1, Thanaa F Moghazy3, Noha S Kandil3, Amira A El-Sayed1 
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

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.


How to cite this article:
Ammar YA, Nienaa YA, El-Banawy SS, Moghazy TF, Kandil NS, El-Sayed AA. Association of vitamin D deficiency with renal anemia and erythropoietin hyporesponsiveness in hemodialysis patients.J Egypt Soc Nephrol Transplant 2017;17:125-131


How to cite this URL:
Ammar YA, Nienaa YA, El-Banawy SS, Moghazy TF, Kandil NS, El-Sayed AA. Association of vitamin D deficiency with renal anemia and erythropoietin hyporesponsiveness in hemodialysis patients. J Egypt Soc Nephrol Transplant [serial online] 2017 [cited 2018 May 25 ];17:125-131
Available from: http://www.jesnt.eg.net/article.asp?issn=1110-9165;year=2017;volume=17;issue=4;spage=125;epage=131;aulast=Ammar;type=0