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Clinical measures identify vitamin D deficiency in dialysis.

ABSTRACT: 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.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.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 < or =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%).Deficiency of 25-hydroxyvitamin D is nearly universal among patients with hypoalbuminemia initiating chronic hemodialysis in winter.

SUBMITTER: Bhan I

PROVIDER: S-EPMC2827576 | biostudies-other | 2010 Mar

REPOSITORIES: biostudies-other

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Clinical measures identify vitamin D deficiency in dialysis.

Bhan Ishir I Burnett-Bowie Sherri-Ann M SA Ye Jun J Tonelli Marcello M Thadhani Ravi R

Clinical journal of the American Society of Nephrology : CJASN 20100225 3

<h4>Background and objectives</h4>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.<h4>Design, setting, participants, & measurements</h4>Nine-hundred eight patients with 25-hydroxyvitamin D levels were identified from the Accelerated Mort ...[more]

PMID: 20185603

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Project description:Vitamin D deficiency and rickets are more common in non-western immigrants and refugees than in the native population. Severe vitamin D deficiency (serum 25-hydroxyvitamin D <25 nmol/l) may occur in up to 50% of children and adults of non-western origin. They are not used to sunshine exposure due to the often excessive sunshine in the country of origin. They usually have a more pigmented skin. Non-western immigrants and refugees often wear skin-covering clothes due to religious or cultural tradition. The food contains little vitamin D with the exception of fatty fish. In addition, many immigrants have a low calcium intake. Complaints may include fatigue, pain in shoulders, ribs, lower back and thighs. Neonates and young children may have spasms and convulsions due to hypocalcemia. Older children and adolescents may have bone pain, muscle weakness and skeletal deformities. Widening of the wrist, chest deformities and bowing of the legs may occur, and longitudinal growth is delayed. In adults, muscle weakness and bone pain are predominant. Laboratory examination may show hypocalcemia and hypophosphatemia and elevated alkaline phosphatase. The serum 25(OH)D is below 25 nmol/l in case of severe vitamin D deficiency with symptoms. Impaired 25-hydroxylation or 1α-hydroxylation may occur in case of severe liver or renal disease or by genetic causes. Radiographs of wrists or knees may show widening of the growth plates and cupping of radius and ulna may confirm the diagnosis. In adolescents and adults, radiographs of painful bones may show pseudofractures or Looser zones. Rickets and osteomalacia are treated by vitamin D3 2000 IU/d in infants, 3000-6000 IU/d in older children in combination with calcium 500 mg /d. In osteomalacia, the adult vitamin D3 dose is 2000-3000 IU/d, combined with calcium 1000-2000 mg/d. Prevention of vitamin D deficiency can be done with vitamin D3 400-800 IU/d, depending on age. Nutritional measures include fortification of milk or other foods.

Project description:Vitamin D deficiency has been described as being pandemic, but serum 25-hydroxyvitamin D [25(OH)D] distribution data for the European Union are of very variable quality. The NIH-led international Vitamin D Standardization Program (VDSP) has developed protocols for standardizing existing 25(OH)D values from national health/nutrition surveys.This study applied VDSP protocols to serum 25(OH)D data from representative childhood/teenage and adult/older adult European populations, representing a sizable geographical footprint, to better quantify the prevalence of vitamin D deficiency in Europe.The VDSP protocols were applied in 14 population studies [reanalysis of subsets of serum 25(OH)D in 11 studies and complete analysis of all samples from 3 studies that had not previously measured it] by using certified liquid chromatography-tandem mass spectrometry on biobanked sera. These data were combined with standardized serum 25(OH)D data from 4 previously standardized studies (for a total n= 55,844). Prevalence estimates of vitamin D deficiency [using various serum 25(OH)D thresholds] were generated on the basis of standardized 25(OH)D data.An overall pooled estimate, irrespective of age group, ethnic mix, and latitude of study populations, showed that 13.0% of the 55,844 European individuals had serum 25(OH)D concentrations <30 nmol/L on average in the year, with 17.7% and 8.3% in those sampled during the extended winter (October-March) and summer (April-November) periods, respectively. According to an alternate suggested definition of vitamin D deficiency (<50 nmol/L), the prevalence was 40.4%. Dark-skinned ethnic subgroups had much higher (3- to 71-fold) prevalence of serum 25(OH)D <30 nmol/L than did white populations.Vitamin D deficiency is evident throughout the European population at prevalence rates that are concerning and that require action from a public health perspective. What direction these strategies take will depend on European policy but should aim to ensure vitamin D intakes that are protective against vitamin D deficiency in the majority of the European population.

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Clinical measures identify vitamin D deficiency in dialysis.

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Clinical measures identify vitamin D deficiency in dialysis.

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