Asociación de déficit de vitamina D y anemia en pacientes en hemodiálisis crónica

Laura Solá; Noel Leyún; Juan Carlos Díaz Salvia; Susana González Rodríguez; Cristina Sehabiague; Karina Parodi; Alicia Olascoaga; Walter Alallón

Authors

Laura Solá Universidad de la República, Facultad de Medicina, Medicina Preventiva y Social. Prof. Adj. Centro de Asistencia del Sindicato Médico del Uruguay, Servicio de Hemodiálisis Crónica. Director
Noel Leyún Centro de Asistencia del Sindicato Médico del Uruguay, entro de Hemodiálisis Crónica. Residente de Nefrología
Juan Carlos Díaz Salvia Centro de Asistencia del Sindicato Médico del Uruguay, Centro de Hemodiálisis Crónica. Nefrólogo
Susana González Rodríguez Centro de Asistencia del Sindicato Médico del Uruguay, Centro de Hemodiálisis Crónica. Nefrólogo
Cristina Sehabiague Centro de Asistencia del Sindicato Médico del Uruguay, Centro de Hemodiálisis Crónica. Nefrólogo
Karina Parodi Centro de Asistencia del Sindicato Médico del Uruguay, Centro de Hemodiálisis Crónica. Lic. en Enfermería
Alicia Olascoaga Universidad de la República, Facultad de Medicina, Laboratorio Clínico. Prof. Agdo. CASMU, Departamento de Laboratorio
Walter Alallón Universidad de la República, Facultad de Medicina, Laboratorio Clínico. Prof. Titular. CASMU, Departamento de Laboratorio

Keywords:

RENAL DIALYSIS, ANEMIA, VITAMIN D DEFICIENCY, INFLAMMATION ERYTHROPOIETIN

Abstract

Introduction: vitamin D deficiency (25VD) is very common.
Objective: to evaluate the prevalence of severe vitamin D deficiency of 25VD (DS-25VD) in chronic hemodialysis patients and its association with metabolic alterations.
Method: cross-sectional study of chronic hemodialysis patients. Age, sex, hospitalizations and erythropoietin doses were recorded. Calcium, phosphorus, hemoglobin, intact parathyroid hormone, ferritin, C-reactive protein (CRP), 25VD and erythropoietin resistance (doses/gram Hb) were measured. Considering DS-25VD lower than 10 ng/ml, anemia was defined when anemia as hemoglobin was lower than 10 g/dL or use of erythropoietin. It was considered to be high upon: ferritin greater than 500 ng/ml and C-reactive protein (CRP) greater than 5 mg/L. Risk of DS-25VD and anemia were estimated using the logistic regression model. Comparisons were made using square chi or t-test according to DS-25VD, considering p < 0.05 was meaningful.
Results: 65 out of 105 patients (61.9%) were male, ages were 69.8 ± 13.2 años; 33 of them (31.4%) were diabetic. Average 25VD was 13,0±7.5 ng/ml, <30 ng/ml in 103 (97%) and 42 (40.8%) had DS-25VD. The DS-25VD was associated with anemia (90.7% vs 75.8%) and moderate-severe anemia (76.7% vs 51.6%). Patients with DS-25VD had a greater resistance to erythropoietin (8.6 vs 5.8), ferritin (592 vs 455 ng/ml) and CRP (15.8 vs 7.6 mg/L). The DS-25VD increased with high CRP (OR: 4.59, IC95% 1.69-12.44) and it increased the risk of anemia (OR: 3.09, IC: 1.06-9.01), adjusted according to age, sex, diabetes and intact parathyroid hormone. Twenty seven patients who were hospitalized had a significantly lower Hb (10.2 ± 1.4 vs 11.2 ± 1.4) and 25VD (10.4 ± 3.8 vs 13.8 ± 8.2).
Conclusions: the DS-25VD is associated to anemia and a greater erythropoietin resistance in chronic hemodialysis patients. The mechanism could imply a greater inflammation (high CRP and ferritin).

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