Treatment with Oral Active Vitamin D Is Associated with Decreased Risk of Peritonitis and Improved Survival in Patients on Peritoneal Dialysis

Kerschbaum, Julia; Vychytil, Andreas; Lhotta, Karl; Prischl, Friedrich C.; Wiesholzer, Martin; Machhold-Fabrizii, Veronika; Kopriva-Altfahrt, Gertrude; Schwarz, Christoph; Balcke, P; Oberbauer, Rainer; Kramar, Reinhard; König, Paul; Rudnicki, Michael

doi:10.1371/journal.pone.0067836

Cited by 28 publications

(25 citation statements)

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“…Moreover, peritonitis could have occurred independently of CKD-MBD, as our study cohort consisted of elderly patients with multiple comorbidities and a high prevalence of diabetes mellitus. (20,21) Although there have been recent reports that active vitamin D use was associated with a significant reduction in the risk of peritonitis (22,23) and longer duration of the first episode of peritonitis, (23) we did not observe any significant differences in the proportion of patients with or without peritonitis with respect to active vitamin D replacement (p = 0.85) or the type of phosphate binders administered (p = 0.83) in the present study.…”

Section: Discussioncontrasting

confidence: 63%

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Chuang

Wong

Vathsala

et al. 2016

smedj

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INTRODUCTIONA complex relationship exists between chronic kidney disease-mineral and bone disorder (CKD-MBD) and adverse outcomes among dialysis patients. This study aimed to report the prevalence of CKD-MBD and examine the impact of achieving target CKD-MBD parameters on morbidity and mortality one year after peritoneal dialysis (PD) initiation. METHODSIn this retrospective cohort study, patients electively initiated on PD were followed up for one year. Laboratory parameters were collected and the prevalence of CKD-MBD 4-6 months after PD initiation was determined based on the Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Linear regression and Cox proportional hazards model were used to evaluate the effects of achieving CKD-MBD targets 4-6 months after PD initiation on hospitalisation, the incidence of peritonitis or exit-site infections (ESIs), and mortality at one year. RESULTSThe prevalence of CKD-MBD among the 86 patients in this study was 86.0% (KDOQI) and 54.7% (KDIGO).There was no significant difference in hospitalisation duration between patients who achieved targets and those who did not. Patients who failed to meet all the KDIGO CKD-MBD or calcium serum targets had a higher incidence of peritonitis or ESI. A trend toward shorter time to death was observed among patients who failed to meet the KDIGO phosphorus serum targets.CONCLUSION There was moderate (KDIGO) to high prevalence (KDOQI) of CKD-MBD among the patients. Achievement of all the KDIGO CKD-MBD or calcium serum targets was associated with reduced peritonitis or ESI, while achievement of the KDIGO phosphorus serum targets was associated with improved survival.

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Section: Discussioncontrasting

confidence: 63%

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Chuang

Wong

Vathsala

et al. 2016

smedj

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“…However, recent study in PD patients did not detect any benefit from paricalcitol supplementation in preventing peritoneal remodeling. In contrast to these results, Kerschbaum et al demonstrated protective effect of oral active VD against peritonitis in PD patients [33,54,76].…”

Section: Anemia and Peritoneal Fibrosismentioning

confidence: 81%

“…Interventional studies also demonstrated the decreased risk for infection in dialysis patients. VD supplementation reduced significantly the risk for hospitalization due to acute respiratory infections in hemodialysis (HD) patients; in another study, VD supplementation decreased the risk for peritonitis in patients on peritoneal dialysis (PD) [53,54]. A more recent study also demonstrated decrease in infection rates in dialysis patients treated with VDR analogs [55].…”

Section: Vd and Infectionmentioning

confidence: 99%

Vitamin D Deficiency in Renal Disease

Filipov¹,

Dimitrov²

2020

Vitamin D Deficiency

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Vitamin D deficiency is highly prevalent in patients with renal disease. The abnormal vitamin D (VD) metabolism in chronic kidney disease (CKD) is a key factor for developing CKD-related mineral bone disease (CKD-MBD), which directly influences the survival of the CKD patients. The importance of VD is perhaps of greater value due to its pleiotropic effects that span beyond calcium-phosphorus metabolism (cancer protection, diabetes prevention, and renal protection). The aim of our chapter is to depict the clinical implications of VD deficiency in the setting of CKD, including VD pleiotropy in renal disease, and to propose the most adequate treatment suggested in the literature. Keywords: vitamin D deficiency, chronic kidney disease, mineral bone disease, vitamin D pleiotropy, vitamin D supplementationVitamin D Deficiency 2 the ratio between free and total 25VD remained unchained; therefore, total 25VD is the indicator of VD status in CKD [3].Generally, 25VD level has reverse association with parathyroid hormone (PTH) levels. In addition, higher 25VD is associated with higher calcium intestinal reabsorption. However, at 25VD ≥ 75 nmol/l, no reduction in PTH levels and no increase in calcium intestinal reabsorption occurs [4, 5]. Therefore, 25VD ≥ 75 nmol/l is regarded as a cut-off value for vitamin D sufficiency.No generally accepted definition for VD deficiency exists, as authors choose cut-off value either serum 25VD of 25 nmol/L [6] or serum 25VD of 50 nmol/L [7]. However, target levels of 75 nmol/L are recommended, taking into consideration the clinical importance of mild VD insufficiency (25VD between 50 and 74.9 nmol/L) [7,8].Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for more than 3 months, with implications for health [one of the following: estimated glomerular filtration rate (eGFR) less than 60 ml/ min/1.73 m 2 ,presence of proteinuria, structural abnormalities of the kidney detected on imaging, pathological findings detected on kidney biopsy, urine sediment pathology, electrolyte abnormalities due to tubular disorders, history of kidney transplantation] [9]. CKD patients are at increased risk for VD deficiency; therefore, they require VD screening [7]. Vitamin D metabolism in health and renal disease VD metabolism in healthy subjectsVD is synthesized predominantly endogenously (approx. to 90% of the total VD in human body). In the skin, the ultraviolet light transforms 7-dehydroxycholesterol (provitamin D) to pre-vitamin D, which under the influence of body temperature spontaneously isomerizes to cholecalciferol (vitamin D3). Approximately, 10% of total body VD is taken orally (vitamin D2, ergocalciferol, and cholecalciferol). VD is transported via VD-binding protein to the liver, where it is hydroxylated to 25VD. The next step in VD activation is hydroxylation of 25VD by the enzyme 1α-hydroxylase (CYP27B1) to 1,25VD, which is the active VD metabolite. The process occurs predominantly in the renal tubules. In addition, non-renal CYP27B1 was detected...

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“…Nevertheless, mineral and bone disorders can have an impact, especially when uremic pruritus [27] or fractures weigh in, causing touch contamination and unqualified PD performance. Kerschbaum et al [28] reported that oral administration of active vitamin D is associated with a lower risk of peritonitis and according to a recent meta-analysis, the use of vitamin D in long-term dialysis patients appears to be associated with lower risk of infection-related outcomes [29]. The effect of educational attainment on peritonitis risk has been discussed in several studies; lower educational level and lower socioeconomic status [3,6,17,14] are associated with higher peritonitis rates.…”

Section: Discussionmentioning

confidence: 99%

Peritonitis: Episode Sequence, Microbiological Variation, Risk Factors and Clinical Outcomes in a North China Peritoneal Dialysis Center

Pei

Qureshi

et al. 2018

Kidney Blood Press Res

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Background/Aims: This study investigated peritonitis episodes with regard to time sequence, microbiological variation, factors associated with peritonitis and clinical outcomes in peritoneal dialysis (PD) patients. Methods: This single-center cohort study enrolled all incident patients who met the inclusion criteria at our center from June 1, 2012 to June 30, 2015 and who were followed until June, 2017. Clinical, biochemical characteristics and detailed data on peritonitis episodes, and hospitalizations were recorded. Results: A total of 218 episodes of peritonitis corresponding to a rate of 0.27 episode per patient-year were recorded. Gram positive bacteria, identified in 115 (52.8%) episodes, were the most common pathogens. The occurrence of enterococcus peritonitis increased from 15.1% of the first to 27.3% of the later episodes. Multivariate logistic regression showed that the presence of cardiovascular disease (CVD, odds ratio [OR] 2.177, 95% confidence interval [95%CI] 1.214–3.903, P=0.009), age≤ 55 (OR 2.282, 95%CI 1.062–4.906, P=0.035), non-independent operator (OR 0.440, 95%CI 0.206–0.938, P=0.034), lower values of potassium (OR=0.671,95%CI 0.472–0.954, P=0.026) and higher values of calcium-phosphate product (OR 1.410, 95%CI 1.065–1.868, P=0.017) were associated with peritonitis. Besides CVD (risk ratio [RR] 2.591, 95%CI 1.893–3.543, P< 0.001) and non-independent operator (RR 0.583, 95%CI 0.439–0.776, P< 0.001), a lower level of education (RR 0.641, 95%CI 0.487–0.842, P=0.001) was associated with higher peritonitis rates in log-linear analysis. Spearman analyses indicated that the time to the 1st episode was negatively related to the peritonitis rate (r=-0.291, P=0.001). Time-dependent Cox regression showed no association between the time to the 1st episode and patient survival (P=0.151). Patients with a high peritonitis rate (HPR) demonstrated worse technique survival (P< 0.001). Conclusion: The present study has revealed several center-based features and modifiable risk factors for peritonitis. The presence of CVD and the need for assistance with PD operation not only increased the odds of peritonitis but were also associated with more peritonitis episodes. Time to first peritonitis was related to the peritonitis rate but not associated with patient survival. Patients with HPR had worse technique survival.

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Treatment with Oral Active Vitamin D Is Associated with Decreased Risk of Peritonitis and Improved Survival in Patients on Peritoneal Dialysis

Cited by 28 publications

References 22 publications

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Vitamin D Deficiency in Renal Disease

Peritonitis: Episode Sequence, Microbiological Variation, Risk Factors and Clinical Outcomes in a North China Peritoneal Dialysis Center

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