Abstract
BackgroundSuboptimal vitamin D status is highly prevalent in Northern communities, particularly in those patients with chronic diseases such as diabetes and chronic renal disease. Emerging literature suggests that adherence to daily vitamin D supplementation may be an important factor influencing vitamin D status and overall bone health, but compliance with therapies for bone health is a major challenge. It is unknown what level of vitamin D supplementation will ameliorate or improve suboptimal vitamin D status in patients with diabetic nephropathy or contribute to improved bone health, particularly for those living in northern climates.Methods/DesignThe study purpose was to examine two different strategies of vitamin D3 supplementation; daily dosing of 2000 IU per day verses monthly dosing of 40,000 IU per month on markers of vitamin D status, bone health and to examine whether adherence, quality of life and patient satisfaction with the supplementation strategy differs between the two vitamin D strategies in adults diagnosed with diabetic nephropathy.DiscussionThe need for RCTs assessing higher doses of vitamin D3 supplementation at varying frequencies of administration and its impact on bone health in adults with diabetes and chronic kidney disease are needed.Trial registrationClinicalTrials.gov NCT01476501.
Highlights
Suboptimal vitamin D status is highly prevalent in Northern communities, in those patients with chronic diseases such as diabetes and chronic renal disease
It is unknown what level of vitamin D supplementation will ameliorate or improve suboptimal vitamin D status in patients with diabetic nephropathy or contribute to improved bone health, for those living in northern climates [5,7,10]
The daily dose was selected based on results from findings that showed that patients with diabetes with stage 3–4 chronic kidney disease (CKD) in Northern Alberta where supplementation with 1000 IU/D vitamin D3 resulted in serum increases of 25(OH) vitamin D less than 25 mmol/L [5,7]
Summary
Suboptimal vitamin D status is highly prevalent in Northern communities, in those patients with chronic diseases such as diabetes and chronic renal disease. Emerging literature suggests that adherence to daily vitamin D supplementation may be an important factor influencing vitamin D status and overall bone health, but compliance with therapies for bone health is a major challenge It is unknown what level of vitamin D supplementation will ameliorate or improve suboptimal vitamin D status in patients with diabetic nephropathy or contribute to improved bone health, for those living in northern climates. Patients with diabetic nephropathy are at increased risk for poor dietary intake of vitamin D due to restrictions on vitamin D rich foods/beverages (e.g. dairy based products) as these products have a high carbohydrate, phosphorus and/or potassium content It is unknown what level of vitamin D supplementation will ameliorate or improve suboptimal vitamin D status in patients with diabetic nephropathy or contribute to improved bone health, for those living in northern climates [5,7,10]. A recent study in patients with stage 3–4 CKD demonstrated that daily oral supplementation of vitamin D3 (1,000 IU/d) for three months resulted in a mean increase in serum 25(OH)D of 25 nmol/L (40 ± 15 nmol/L pre- vs. 68 ± 25 nmol/L post-supplementation); a significantly lower level of 25(OH)D than is thought to optimize bone health (>100 nmol/L) [12,23,24,25]
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