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Dialysis patients need real vitamin D – Editorial July 2013

The Many Forms and Functions of Essential Vitamin D for Dialysis Patients

Journal of Renal Nutrition, Volume 23, Issue 4 , Pages e87-e88, July 2013
Caroline Hamatake, MPH, RD caroline.hamatake at fmc-na.com
Liberty Dialysis–Hawaii, Honolulu, Hawaii
Feature Editor: Catherine M. Goeddeke-Merickel, MS, RD, LD

The screening and treatment of vitamin D deficiency is now routinely done in most dialysis clinics. Many dialysis patients have suboptimal levels of serum 25-hydroxyvitamin D and require vitamin D supplementation even in clinics located in the tropics.

Convincing patients to take a vitamin D supplement has been a challenge, however.
1 Barriers to vitamin D supplementation include confusion about different forms of vitamin D,
2 the lack of knowledge regarding the benefits of adequate vitamin D levels, resistance to an increased daily pill burden, and the potential out-of-pocket cost for “another pill.”

Many patients believe that the vitamin D analog (e.g., oral calcitriol, Hectoral, or Zemplar) they receive in the dialysis clinic is sufficient to address their low serum 25-hydroxyvitamin D level. Their confusion is understandable on the basis of the umbrella term “vitamin D” that is commonly used to refer to the various forms of this hormone-like vitamin in the lay literature and among members of the health team. For example, medical professionals mistakenly tell patients “this is vitamin D” when they administer a vitamin D analog instead of the more accurate “this is an analog of 1,25-dihydroxyvitamin D.”

Requesting patients to add another pill to their daily medication routine is another challenge. In the Transtheoretical Model of Change,3 knowledge of the benefit of a new behavior, or the risk of not adopting a new behavior, empowers a patient to make a behavior change. Therefore, a summary of the benefits of supplemental vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) and the risks associated with low serum 25-hydroxyvitamin D levels 4 would help patients more easily surmount their resistance to an increased pill burden and out-of-pocket costs. However, such a patient-friendly summary of the benefits and risks has not been readily available for patient education.

Thus, a 1-page handout was developed to aid in the education of dialysis patients receiving vitamin D supplementation. (VitaminDWiki was unable to find the PDF)
This patient education handout uses a schematic diagram to illustrate the relationship between the different forms and functions of vitamin D.

Providing additional information such as a list of dietary sources of vitamin D to further explain the difficulty in consuming adequate amounts through food and a list of acceptable vitamin D products available in their respective communities to this 1-page educational handout may be helpful.


Vitamin D in CKD population:

General information on vitamin D in health (e.g., functions, dietary sources):

List of dietary sources of vitamin D:


  • KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Chapter 4.2: Treatment of abnormal PTH levels in CKD-MBD. Kidney Int. 2009;76(suppl 113):S50–S99
  • Blair D, Byham-Gray L, Lewis E, McCaffrey S. Prevalence of vitamin D [25(OH)D] deficiency and effects of supplementation with ergocalciferol (vitamin D2) in stage 5 chronic kidney disease patients. J Ren Nutr. 2008;18:375–382
  • Substance Abuse and Mental Health Services Administration. General information and links on stages of change and motivational interviewing.
    http://www.samhsa.gov/co-occurring/topics/training/change.aspx. Accessed May 13, 2013.
  • Joao Matias P, Jorge C, Ferreria C, et al. Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters. Clin J Am Soc Nephrol. 2010;5:905–911

PDF of this article is attached at the bottom of this page

See also VitaminDWiki

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