Vitamin D deficiency and anemia in early chronic kidney disease

Abstract

Vitamin D has a number of pleiotropic effects in a variety of tissues, in addition to its well-known effects on mineral metabolism. To determine whether it has an effect on erythropoiesis, we studied the association of the components of the vitamin D axis with the prevalence and severity of anemia in chronic kidney disease. We measured the concentrations of 25-hydroxyvitamin D (25D), 1,25-dihydroxyvitamin D (1,25D), and hemoglobin in a cross-sectional study of 1661 subjects in SEEK, a multi-center cohort study of chronic kidney disease patients in the United States, of whom 41% met the criteria for anemia. The mean hemoglobin concentrations significantly decreased with decreasing tertiles of 25D and 1,25D. These linear trends remained significant after adjustment for age, gender, ethnicity, eGFR, diabetes, and parathyroid hormone. In similarly adjusted models, the lowest tertiles of 25D and 1,25D were independently associated with 2.8- and 2.0-fold increased prevalence of anemia compared with their respective highest tertiles. Patients with severe dual deficiency of 25D and 1,25D had a 5.4-fold prevalence of anemia compared with those replete in both. Our study shows that 25D and 1,25D deficiency are independently associated with decreased hemoglobin levels and anemia in chronic kidney disease. Whether this association is causal requires further study.

Correlation Between Levels of 25-Hydroxy-Vitamin D and Degree of Anemia in Patients with Chronic Kidney Disease

“…According to the results of this work, Patel et al [13] studied 1661 patients with renal disease. Levels of 25(OH)D and 1.25(OH) 2 D of these patients were independently correlated with decreased levels of hemoglobin and anemia.…”

Hb level in relation to vitamin D status in healthy infants and toddlers

“…Infants' Hb level, serum Fe as well as 25(OH)D concentrations were increased after they were treated with intramuscular iron dextran (13) . Studies on patients with chronic kidney disease have also supported this association (14,15) .…”

Ergocalciferol Supplementation in Hemodialysis Patients With Vitamin D Deficiency: A Randomized Clinical Trial

“…6 A reduction in ESA dose has been found in nonrandomized trials of nutritional vitamin D supplementation in patients on hemodialysis, [6][7][8] and cross-sectional studies show an inverse relationship between serum 25(OH)D and hemoglobin and ESA dose. [9][10][11][12] In vitro and in vivo studies under conditions of vitamin D deficiency have demonstrated increased erythropoeisis with addition of vitamin D. 13,14 The postulated mechanism for nutritional vitamin D's effect is via the suppression of cytokines inhibitory to erythroid progenitors. 14 Increased availability of iron through suppression of hepcidin may also play a role.…”