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Virtually all black dialysis patients with low albumin are vitamin D deficient in the winter – Mar 2010

Editorial followed by abstract of the article

Virtually all kidney disease patients on dialysis have vitamin D deficiency

March 18, 2010 by: S. L. Baker,

Ishir Bhan, MD, of Massachusetts General Hospital, and his research team studied data from 908 U.S. dialysis patients in the Accelerated Mortality on Renal Replacement (ArMORR) cohort. The scientists' goal was to investigate routinely measured clinical and demographic characteristics to see if they could figure out which patients with end-stage renal disease (ESRD) on dialysis are at increased risk for vitamin D deficiency.

The results showed that 79% of the patients in the study were vitamin D deficient. The strongest predictors of a lack of vitamin D were being African-American, female, the winter season, and low blood levels of the protein albumin. In fact, when all these factors came together, the result was that every single kidney disease patient was deficit in vitamin D.

Specifically, the researchers found that if black dialysis patients had low blood albumin levels during the winter season, the likelihood they would be vitamin D deficient increased from 90% to 100% for women and from 85% to 100% for men. Their white counterparts fared only slightly better, with their risk of vitamin D deficiency rising from 82% to 94% in women and from 66% to 92% in males.

"This research identifies risk factors for nutritional vitamin D deficiency in the dialysis population and may provide clues to its biology in this population," Dr. Bhan said in a statement to the media.

So what is going on here that makes ESRD patients on dialysis so vulnerable to vitamin D deficiency? The scientists pointed out in their media statement that although previous studies have suggested that patients on dialysis have an impaired ability to generate vitamin D when they are exposed to adequate sunlight, their study indicates that skin-based production of vitamin D is likely to be important in patients with ESRD.

Although the researchers did not discuss the issue in their paper, their findings raise a which-came-first type issue. Is it possible vitamin D is at least part of the cause of serious kidney disease, and not merely a byproduct of the illness? With a growing number of chronic and serious illnesses - - including heart disease (http://www.naturalnews.com/027580_v...) and breast cancer (http://www.naturalnews.com/027393_c...) - - now firmly linked to vitamin D deficiency, the idea that a lack of vitamin D could be a causative factor in ESRD would seem to be a possibility worthy of investigation.
For more information: http://cjasn.asnjournals.org/cgi/content/abstract/5/3/460


Clinical Measures Identify Vitamin D Deficiency in Dialysis

Clin J Am Soc Nephrol 5: 460-467, 2010
© 2010 American Society of Nephrology
doi: 10.2215/CJN.06440909 Ishir Bhan*,{dagger}, Sherri-Ann M. Burnett-Bowie{ddagger}, Jun Ye*, Marcello Tonelli§, and Ravi Thadhani*

  • Division of Nephrology, {dagger} Laboratory of Computer Science, and {ddagger} Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; and § Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Correspondence: Dr. Ishir Bhan,Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 750, Boston, MA 02114. Phone: 617-726-3934; Fax: 617-726-8481; E-mail: ibhan at partners.org

Background and objectives: Vitamin D deficiency (defined by serum levels of 25-hydroxyvitamin D) is common in patients with ESRD on hemodialysis, but risk factors are unknown. This study was conducted to determine whether routinely measured clinical and demographic parameters could identify dialysis patients who are vitamin D deficient.

Design, setting, participants, & measurements: Nine-hundred eight patients with 25-hydroxyvitamin D levels were identified from the Accelerated Mortality on Renal Replacement (ArMORR) cohort of incident U.S. dialysis patients and were divided into training (60%) and validation (40%) sets. Predictive models were generated from routinely assessed clinical and demographic data in the training set using logistic regression modeling, neural networks, and decision trees with vitamin D deficiency as the dependent variable. Models underwent progressive variable reduction to identify the simplest model that remained predictive.

Results: Seventy-nine percent of the population was vitamin D deficient (25-hydroxyvitamin D <30 ng/ml). Black race, female sex, winter season, and hypoalbuminemia (serum albumin ?3.1 g/dl) were the strongest predictors of vitamin D deficiency. In the validation set, the presence of hypoalbuminemia and winter season increased the likelihood of vitamin D deficiency in black women (from 90% to 100%), black men (from 85% to 100%), white women (from 82% to 94%), and white men (from 66% to 92%).

Conclusions: Deficiency of 25-hydroxyvitamin D is nearly universal among patients with hypoalbuminemia initiating chronic hemodialysis in winter.

See also VitaminDWiki

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