Peritoneal dialysis probably consumes a lot more vitamin D than haemodialysis

Peritoneal dialysis filters out Vitamin D from the blood - it needs to be replaced.

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Peritoneal dialysis appears to lead to low Vitamin D, anemia, inflammation, etc. - Sept 2021

Low serum vitamin D concentration is correlated with anemia, microinflammation, and oxidative stress in patients with peritoneal dialysis
J Transl Med . 2021 Sep 27;19(1):411. doi: 10.1186/s12967-021-03077-w.
Chi Zhang 1 2, Junsheng Wang 1, Xiaohui Xie 1, Dong Sun 3 4

Background: Peritoneal dialysis (PD) is a form of dialysis to replace the function of kidney, that uses the peritoneum as a dialysis membrane to remove metabolites and water retained in the body. Vitamin D deficiency is prevalent in patients treated with PD. This research investigated the correlation between serum 25-hydroxyvitamin D 25(OH)D concentration and anemia, microinflammation, and oxidative stress in PD patients.

Methods: 62 PD patients and 56 healthy volunteers were recruited in this research. Serum concentrations of 25(OH)D and basic parameters of anemia were detected. The correlation between serum 25(OH)D concentration with anemia, oxidative stress, and microinflammatory state were analyzed.

Results: In the PD group, the concentration of 25(OH)D was lower than the healthy control (HC) group (p < 0.001). Hemoglobin, red blood cell count (RBC), and total iron binding capacity (TIBC) in the PD group was significantly lower (all p < 0.001), while high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) concentrations were significantly higher, than the HC group (all p < 0.001). In the PD group, malondialdehyde (MDA) concentration was higher than in the HC group (p < 0.001), while superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were lower (both p < 0.001). Serum 25(OH)D exhibited positive correlation with hemoglobin (r = 0.4509, p = 0.0002), RBC (r = 0.3712, p = 0.0030), TIBC (r = 0.4700, p = 0.0001), SOD (r = 0.4992, p < 0.0001) and GSH-Px (r = 0.4312, p = 0.0005), and negative correlation with hs-CRP (r = - 0.4040, p = 0.0011), TNF-α (r = - 0.4721, p = 0.0001), IL-6 (r = - 0.5378, p < 0.0001) and MDA (r = - 0.3056, p = 0.0157).

Conclusion: In conclusion, reduced serum 25(OH)D concentrations in PD patients contribute to anemia, oxidative stress and microinflammatory state.
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Peritoneal dialysis and low Vitamin D - April 2014

Serum 25-hydroxy vitamin D concentrations are more deficient/insufficient in peritoneal dialysis than haemodialysis patients in a sunny climate
Journal of Human Nutrition and Dietetics DOI: 10.1111/jhn.12234
K. Hanna1,k.hanna@qut.edu.au, R. G. Fassett2,3, E. Gill2, H. Healy2, M. Kimlin1, L. Ross2 andS. Ash1
1Queensland University of Technology, Brisbane, QLD, Australia
2Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
3The University of Queensland, Brisbane, QLD, Australia

Background: Research has identified associations between serum 25(OH)D and a range of clinical outcomes in chronic kidney disease and wider populations. The present study aimed to investigate vitamin D deficiency/insufficiency in dialysis patients and the relationship with vitamin D intake and sun exposure.

Methods: A cross-sectional study was used. Participants included 30 peritoneal dialysis (PD) (43.3% male; 56.87 ± 16.16 years) and 26 haemodialysis (HD) (80.8% male; 63.58 ± 15.09 years) patients attending a department of renal medicine. Explanatory variables were usual vitamin D intake from diet/supplements (IU day−1) and sun exposure (min day−1). Vitamin D intake, sun exposure and ethnic background were assessed by questionnaire. Weight, malnutrition status and routine biochemistry were also assessed. Data were collected during usual department visits. The main outcome measure was serum 25(OH)D (nm).

Results: Prevalence of inadequate/insufficient vitamin D intake differed between dialysis modality, with 31% and 43% found to be insufficient (<50 nm) and 4% and 33% found to be deficient (<25 nm) in HD and PD patients, respectively (P < 0.001). In HD patients, there was a correlation between diet and supplemental vitamin D intake and 25(OH)D (ρ = 0.84, P < 0.001) and average sun exposure and 25(OH)D (ρ = 0.50, P < 0.02). There were no associations in PD patients. The results remained significant for vitamin D intake after multiple regression, adjusting for age, gender and sun exposure.

Conclusions: The results highlight a strong association between vitamin D intake and 25(OH)D in HD but not PD patients, with implications for replacement recommendations. The findings indicate that, even in a sunny climate, many dialysis patients are vitamin D deficient, highlighting the need for exploration of determinants and consequences.

Publisher rents PDF for $6

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See also VitaminDWiki

• Kidney Dialysis clinics reluctant to add vitamin D treatment as they are not reimbursed – Oct 2012
• Dialysis patients who added Vitamin D were 41 percent less likely to get infection – Meta-analysis July 2018
• Dialysis patients need real vitamin D – Editorial July 2013

Overview Kidney and vitamin D contains the following summary

• FACT: The Kidneys are not the primary way to activate vitamin D; the tissues are
• FACT: When the Kidney has problems, there is less active vitamin D (Calcitriol) for the body
• FACT: When the Kidney has problems, there is increased death due to many factors - many of which are associated with lack of Calcitriol
• FACT: There are many ongoing intervention clinical trials trying to determine how much of what kind of vitamin D is needed to treat the problem
• FACT: One Randomized Controlled Trial has proven that Vitamin D treats CKD
• FACT: 38% of seniors have Chronic Kidney Disease and most are unaware of it CDC statistics 2020
• FACT: Taking extra Vitamin D, in various forms, does not cause health problems - even if poor kidney
• Suggestion: Increase vitamin D getting into body now - and increase co-factors so that the vitamin D can be better used
    Sun, UV lamp, Vitamin D supplement - probably > 5,000 IU,
  Nanoemulstion vitamin D (inside cheek, topically) gets activated Vitamin D to the cells without the need for healthy kidney, liver, or intestine
  Calcitriol - which bypasses the need for the kidney to activate vitamin D
    Problems with Calcitriol however: typically only lasts for a few hours, also, possible complications
      Update: Pre-cursor of active vitamin D made from plants is better than calcitriol – Sept 2012
• Category Kidney and Vitamin D contains 229 items

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See also Web

• Some hemodialysis machines decrease the vitamin D level by 17% compared to the other machines
  “Impact of the type of dialysis membranes on the circulating concentration of markers of vitamin D metabolism” is at
  https://www.ncbi.nlm.nih.gov/pubmed/28222207
• Dialysis Wikipedia
  Hemodialysis, Paediatric Dialysis, Peritoneal dialysis, Hemofiltration, Hemodiafiltration. Intestinal dialysis

• Dialysis types has the following chart

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Effects of vitamin D on parathyroid hormone and clinical outcomes in peritoneal dialysis: a narrative review.

J Nephrol. 2014 Jul 11.
Russo R1, Ruospo M, Cozzolino M, De Nicola L, Icardi A, Paoletti E, Mazzaferro S.
1Division of Nephrology, Dialysis and Transplantation, Azienda Ospedaliero Universitaria Consorziale, Policlinico di Bari, Piazza G. Cesare, 11, 70124, Bari, Italy, roberto.russo at policlinico.ba.it.

Vitamin D deficiency is very prevalent in dialysis and peritoneal dialysis (PD) patients show lower levels of cholecalciferol (25(OH)D3) than hemodialysis patients. We conducted a systematic narrative review to assess the effects of vitamin D therapy on control of secondary hyperparathyroidism and clinical outcomes induced by vitamin D pleiotropic effects. Medline database was searched for cohort and intervention studies reporting data on vitamin D (all sterols including synthetic analogs) and peritoneal dialysis without language restriction. Two authors independently extracted data. Twenty-nine observational and eleven interventional studies were identified for inclusion (1,036 subjects). PTH levels decreased in twenty-nine studies, increased in one study and remained stable in ten studies. Thirty-three studies analyzed the oral route for vitamin D administration, ten the intraperitoneal, one the subcutaneous and one the intravenous. A significant decrease of peritonitis risk was observed in two studies. Proteinuria decreased in four studies and remained stable in one study. Peritoneal protein loss decreased in one study and was stable in two studies. Studies on the therapeutic effects of vitamin D in PD are limited and describe small population samples. Moreover, vitamin D compounds do not consistently reduce PTH levels. The administration of active vitamin D in PD may have interesting pleiotropic effects such as decreasing proteinuria and peritoneal protein loss. According to these effects, vitamin D could help to preserve residual renal function and ensure efficient peritoneal membrane dialysance.

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Peritoneal Dialysis associated with Global Cognitive Impairment (via low vitamin D) Dec 2015

Vitamin D Status Is an Independent Risk Factor for Global Cognitive Impairment in Peritoneal Dialysis Patients
PLoS One. 2015 Dec 2;10(12):e0143782. doi: 10.1371/journal.pone.0143782. eCollection 2015.
.Liu GL1, Pi HC2, Hao L1, Li DD1, Wu YG1, Dong J2.

OBJECTIVE: Vitamin D (VD) deficiency is an independent risk factor for cognitive impairment (CI) in the general population, but VD status in peritoneal dialysis (PD) patients has not been investigated. In this study, we aimed to investigate the relationship between serum VD levels and global and specific cognitive functions in PD patients.

DESIGN AND SETTING: Cross-sectional study, simultaneously conducted at two PD centers.

PATIENTS: Clinically stable patients (n = 273) undergoing PD for at least 3 months were enrolled over a period of one year.

MAIN OUTCOME MEASURES: Demographic and comorbidity data were recorded, and routine biochemical parameters and serum 25-hydroxyvitamin D (25(OH) D) levels of overnight fasted patients were determined. Global cognitive function was assessed by the Modified Mini-Mental State Examination (3MS) score; executive function, by the trail making tests (Trails A and B ); and immediate memory, delayed memory, and language ability by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) sub-tests.

RESULTS: In the univariate analysis, serum 25(OH) D levels significantly correlated with 3MS scores (r = -0.139; P = 0.02), and Trail A (r = -0.188; P = 0.002) and B (r = -0.154; P = 0.01) completion times. In the multivariate analysis, 25(OH) D was found to be independently associated with global CI, but not with executive dysfunction. Serum 25(OH) D could not predict scores of immediate/delayed memory and language ability.

CONCLUSIONS: VD deficiency is highly prevalent in PD patients and is an independent risk factor for global CI in this patient cohort.
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