Association of Vitamin D Deficiency with Renal Anemia and Erythropoietin Hyporesponsiveness in Hemodialysis Patients

Abstract

Background and Aim: The erythropoietin (EPO) response is usually hypo responsive in patients on maintenance hemodialysis (MHD). EPO requirements in chronic kidney disease patients are inversely associated with vitamin D levels. By suppressing chronic inflammation, reducing hyperparathyroidism, or stimulating erythroid progenitors, vitamin D supplementation may improve response to EPO. Anemia and hypo responsiveness of erythropoietin in patients undergoing hemodialysis were investigated in the current study. Patients and Methods: This cross-sectional study was conducted on 40 hemodialysis patients with anemia in Nephrology department, of Mayo Hospital, Lahore from 21st January 2021 to 20th February 2022. As controls, 30 healthy people of the same age and gender were used. Study protocol was approved by institute research and ethical committee. Each individual provided written informed consent. ERI calculation, total iron-binding capacity, complete blood profile, serum iron, alkaline phosphate, vitamin D, ferritin, interleukin (IL-6), calcium, and C-reactive protein were the baseline laboratory parameters measured. Oral α-calcidol therapy was used for follow-up for 3 months. SPSS version 26 was used for data analysis. Results: The overall mean age was 46.82±16.37 years. Of the total 40 HD patients, there were 20 (50%) male and 20 (50%) females. Based on comparison made for hemodialysis patients before and after α-calcidol therapy (P2), there were significant decrease in ERI from 7.42±1.24 to 6.59±1.1 IU/kg/g/dl and significant increase in Hb from 8.37±0.8 to 9.52±0.9 g/dl. Inflammatory markers such as hepcidin, C-reactive protein, ferritin, and IL-6 significantly decreased. There was a substantial positive relation between ERI and serum ferritin (P=0.03) at the start of the trial, and a significant negative correlation between blood vitamin D3 level and ALP (P=0.003). There was a significant negative connection between blood vitamin D3 level and serum ferritin (P=0.005) and IL-6 (P=0.02) levels at the conclusion of the trial. Conclusion: The present study found that hemoglobin levels in HD patients are significantly increased following a 3 month course of oral alfacalcidol supplementation. Improvements in these patients' chronic inflammatory status and control of hyperparathyroidism appear to be associated with and mediated by ameliorative effects. To manage anemia and mineral metabolism in DKD patients effectively, PTH hypersecretion must be controlled effectively. Supplementing HD patients with vitamin D increases their response to EPO and increases its cost-effectiveness within CKD-MBD guidelines. Keywords: Vitamin D deficiency, Renal anemia, Erythropoietin, Hemodialysis