Chronic Kidney Disease and Diabetes Mellitus Predict Resistance to Vitamin D Replacement Therapy

Alshayeb, Hala M.; Wall, Barry M.; Showkat, Arif; Quarles, L. Darryl; Mangold, Therese A.

doi:10.1097/maj.0b013e31826af2d3

Cited by 7 publications

(4 citation statements)

References 37 publications

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“…The non‐diabetics became 10% deficient, 80% insufficient, and only 10% had sufficient 25(OH)D concentration. This was in contrast to Alshayeb et al . who demonstrated that the presence of diabetes and CKD was associated with resistance to a correction of 25(OH)D deficiency and they required higher doses of vitamin D to achieve similar increases in 25(OH)D than the non‐diabetic counterpart.…”

Section: Discussioncontrasting

confidence: 62%

Study of the effect of vitamin D supplementation on glycemic control in type 2 diabetic prevalent hemodialysis patients

Ibrahim

Sarhan

Halawa

et al. 2015

Hemodialysis International

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Vitamin D is claimed to have an adjuvant effect on glycemic control by dual action on pancreatic β-cells and insulin resistance. The aim of this study was to assess the possible effect of short-term alfacalcidol supply on glycemic control in type 2 diabetic hemodialysis (HD) patients. Twenty type 2 diabetic HD patients (using diet and oral drugs but not insulin) were randomly selected from our dialysis unit as well as 20 non-diabetic HD patients as control. A third group of 12 healthy subjects were studied as well. All three groups were similar in age, sex, and body mass index. Oral alfacalcidol therapy was administrated daily as recommended by Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for 12 weeks guided by monthly serum phosphorus and Cax PO4 product. Corrected total calcium, phosphorus, intact parathyroid hormone, 25-hydroxy vitamin D (25[OH]D), and glucoparameters (fasting blood glucose, glycated hemoglobin [HbA1c%], insulin resistance by homeostatic model assessment, and β-cell function by HOMA-β%) were measured under basal conditions and after 3 months of therapy. 25(OH)D was non-significantly lower in diabetic than non-diabetic HD patients, but significantly lower than healthy subjects at the start of the study. However, vitamin D level increased significantly after 3 months of trial, although the levels did not reach normal values. This vitamin D rise was associated with highly significant improvement in concentrations of fasting blood sugar (FBS), fasting insulin, HbA1c%, and HOMA-β-cell function in diabetic and non-diabetic controls. However, there was a significant rise in insulin resistance after treatment. The percentage of change was evident more in diabetics regarding FBS and 25(OH)D concentration. Adjustment of 25(OH)D level in type 2 diabetic prevalent HD patients may improve, at least with short-term therapy, glycemic control mainly through improving β-cell function.

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Section: Discussioncontrasting

confidence: 62%

Study of the effect of vitamin D supplementation on glycemic control in type 2 diabetic prevalent hemodialysis patients

Ibrahim

Sarhan

Halawa

et al. 2015

Hemodialysis International

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“…We found an increased prevalence of vitamin D deficiency in DM patients as compared to no DM ones. Higher prevalence of vitamin D deficiency in DM associated with CKD was evidenced both in pre dialysis CKD [ 15 , 16 , 30 ] as well as in patients undergoing renal replacement therapy [ 31 , 32 ] and it was attributed to urinary loss or resistance to vitamin D replacement therapy [ 15 , 33 ]. However the results published in the recent years are heterogeneous because of the use of different cut-off levels for the definition of vitamin D deficiency.…”

Section: Discussionmentioning

confidence: 99%

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

Schiller

Gădălean

Schiller³

et al. 2015

PLoS ONE

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BackgroundEnd 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.MethodsOur 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 than12 ng/mL.ResultsPatients 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.ConclusionsESRD 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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“…The underlying mechanism needs to be evaluated in prospective studies. Furthermore, the disturbed signaling of VDR has been demonstrated in patients with cardiac disorders and chronic kidney disease ( (Alshayeb, Wall, Showkat, Quarles, & Mangold, 2013). Finally, some findings suggest that glomerular filtration rate and parathyroid hormone are significantly associated with VD metabolism in men without CKD (Karhapää et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Study of the relationship between vitamin D deficiency, sunlight incidence and skeletal/extra skeletal diseases

Câmara

Brandão

2020

Acta Sci. Health Sci.

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It is estimated that more than 1 billion people worldwide have vitamin D insufficiency or deficiency. Vitamin D participates in bone mineralization, and is therefore important in osteoporosis, osteomalacia and rickets prevention. However, vitamin D deficiency could also be associated with several other pathologies. The present study aimed to investigate the relationships between vitamin D deficiency and vitamin D deficiency-related disorders in patients. In addition, this study aims to verify if countries with low solar incidence have higher extraskeletal disease death rates when compared to countries with high solar incidence. The vitamin D concentrations were obtained from the Heart Hospital database (Natal/Brazil). The relationship between solar incidence and death rate for vitamin D deficiency-related disorders was verified. Death rate data were extracted from the ‘World Life Expectancy’ repository and data about solar incidence were obtained from NASA’s Surface Meteorology and Solar Energy project. These data were statistically processed with IBM SPSS v23.0 software and R programming language. Our results showed that patients with vitamin D insufficiency/deficiency showed significantly more bone diseases, thyroid diseases, hypercholesterolemy, hypertriglyceridemia, cancers, diabetes, hepatobiliary diseases, and urinary system diseases. Moreover, countries with high solar incidence have low cancer and multiple sclerosis death rates. This work suggests the participation of vitamin D and sunlight incidence in several diseases.

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Chronic Kidney Disease and Diabetes Mellitus Predict Resistance to Vitamin D Replacement Therapy

Abstract: The presence of CKD and diabetes mellitus is associated with resistance to correction of 25(OH)D deficiency with vitamin D2 therapy. The underlying mechanism needs to be evaluated in prospective studies.

Cited by 7 publications

References 37 publications

Study of the effect of vitamin D supplementation on glycemic control in type 2 diabetic prevalent hemodialysis patients

Study of the effect of vitamin D supplementation on glycemic control in type 2 diabetic prevalent hemodialysis patients

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

Study of the relationship between vitamin D deficiency, sunlight incidence and skeletal/extra skeletal diseases

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