Plasma exchange cut vitamin D levels in half

Created August 2012

PLASMA EXCHANGE INDUCES VITAMIN D DEFICIENCY.

Abstract of poster presented at Vitamin D Workshop June 2012

T.F. Hiemstra, A. Casian, P. Boraks, D R. Jayne, I. Schoenmakcrs Department of Medicine, University of Cambridge, CB2 OQQ United Kingdom

Plasma exchange (PEX) is a widely used immune-modulating therapy for diseases mediated by antibodies or pathogenic proteins, or for transplant desensitisation. Vitamin D (25(OH)D) deficiency is associated with skeletal and extra-skeletal pathology, is permissive to activity of a number of autoimmune diseases, and may be associated with poorer renal allograft survival.

We asked whether PEX would induce vitamin D deficiency through removal of its carrier, the 56kDa vitamin D binding protein (DBP) .

We performed a single-centre prospective cohort study of patients receiving plasma exchange at Addenbrooke's Hospital, Cambridge. Vitamin D metabolites, DBP and biochemical parameters were measured before the start and after every plasma exchange treatment, as well as 7 and 28 days after completion of PEX. 11 Caucasian European patients (7 males) aged 59 ± 13 years received 5.5 ± 0.9 PEX treatments, for ANCA-associated vasculitis (n=5), myasthenia gravis (n=3), paraneoplastic neuropathy (n=2) and voltage-gated potassium channel antibody-mediated encephalopathy (n=l). Baseline estimated glomerular filtration rate was 56.9 ± 39.5 ml/min/ 1.73m2, and 5 patients had chronic kidney disease stage 3 or worse.

Baseline 25(OH)D levels were 50.6 ± 30.1 nmol/L.

PEX

significantly reduced 25(OH)D levels after 5 treatments to 22 ± 9.4nmol/L (p = 0.0017), and vitamin D
remained low 7 days (26.4 ± 9.8nmol/L, p=0.02) and
28 days (30.8 ± 15.5, p=0.048) after cessation of PEX.

la25(OH)2D3 levels reduced from 103 ± 52pmol/L to 42 ± 4pmol/L (p = 0.003) with PEX, but had returned to baseline levels after 7 days. PEX also significantly reduced DBP levels from 206.5 ± 64.7ug/mL to 98.5 ± 34u.g/mL (p = 0.0001), but levels had returned to baseline after 7 days.

PEX significantly reduced corrected Calcium from 2.23 ±0.12 mmol/L to 1.98 ± 0.08 mmol/L (p = 0.0007), but did not alter phosphate.

Analyses of plasma effluent confirmed removal of DBP, 25(OH)D and PTH by PEX.

In conclusion, we identified sustained reduction in 25(OH)D and acute reversible reduction in l,25(OH)2D3 by a typical course of PEX, likely through its removal with DBP in plasma effluent.

This vitamin D deficiency is likely to offset the benefit of PEX.

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Summary and comment by VitaminDWiki

It would appear that following a plasma exchange that a person needs to get restocked with vitamin D

20 ng initially
9 ng following 5 plasma exchanges
11 ng after 7 days
12 ng after 28 days

PLASMA EXCHANGE is used for (from WikiPedia)

Multiple sclerosis

Guillain-Barré syndrome

Chronic inflammatory demyelinating polyneuropathy

Goodpasture's syndrome

Hyperviscosity syndromes: Cryoglobulinemia, Paraproteinemia, Waldenström macroglobulinemia

Myasthenia gravis

Thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome

Wegener's granulomatosis

Lambert-Eaton Syndrome

Antiphospholipid Antibody Syndrome (APS or APLS)

Microscopic polyangiitis

Recurrent focal and segmental glomerulosclerosis in the transplanted kidney

HELLP syndrome

PANDAS syndrome

Refsum disease

Behcet syndrome

HIV-related neuropathy

Graves' disease in infants and neonates

Pemphigus vulgaris

Rhabdomyolysis

Toxic Epidermal Necrolysis (TEN)

Plasma exchange cut vitamin D levels in half

PLASMA EXCHANGE INDUCES VITAMIN D DEFICIENCY.

Summary and comment by VitaminDWiki

PLASMA EXCHANGE is used for (from WikiPedia)

See also VitaminDWiki

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