Study of Vitamin D3 Level in Egyptian Hemodialysis Patients and The Effect of Replacement Therapy

Abstract

Background: The ability of extrarenal tissues to convert 25- hydroxyvitamin D [25(OH)D] into 1,25-hydroxyvitamin D [1,25(OH)2D] and its dependence on substrate levels provide the rationale for supplementing vitamin D in dialysis patients who usually have severe depletion of both: calcitriol and vitamin D. The primary aim of the study was to detect serum Vit d3 levels in a cohort of Egyptian Hemodialysis patients and to check the effect of its replacement on serum levels serum1,25(OH)2D in hemodialysis patients with vitamin D deficiency. Secondary outcomes were changes in serum calcium, phosphate, parathyroid hormone (PTH). Patients and Methods: 40 patients (25 males and 15 females) with Chronic Kidney Disease CKD (stage V) on regular hemodialysis, attending at Nephrology unit, Internal medicine department, Mansoura University Hospital during the period from January to June 2020. Another 40 persons- Age and sex-matched was selected randomly from the medical workers and served as a control group. According to laboratory investigation and clinical examination, deficient patients were treated with Devarol-S (cholecalciferol) for 3 months and then revaluated. Deficient patients received 50000 IU monthly for 3 Consecutive months. Results: The study was carried out on 80 persons, 27 male patients (73.0%) and 13 female patients (27.0%). Their mean age was (47.16±14.92) years. The mean dialysis duration is (4.68±2.42) years, and 40 people as the control group. 3 Months after vitamin D replacement, a significant increase in serum calcium (8.33 to 8.89) mg/dL, phosphorous (4.99 to 5.85) mg/dL, and Vit D (4.01 to 28.43) ng/mL levels compared to pretreatment level. There is also a significant decrease in parathormone hormone level (419.30 to 377.20) pg/mL. After 3 months of follow-up, there was no significant change in the levels of haemoglobin, KT/v, Albumin, and alkaline phosphatase in the overall sample (p-value = 0.7, 0.4, 0.29, and 0.59, respectively). Conclusions: In most patients, treatment with cholecalciferol in a 50000 IU / month dose permits safe correction of vitamin D deficiency. It is more effective than small doses of alfacalcidol in rising serum 1,25(OH)2D. Keywords: Vitamin d level; Egyptians; Hemodialysis; Supplementation.