Low Dietary Intake of Vitamin D and Vitamin D Deficiency in Hemodialysis Patients.
Low Dietary Intake of Vitamin D and Vitamin D Deficiency in Hemodialysis Patients.
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DOI：
10.4172/2161-0959.1000166
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发表时间：
2014-05
期刊：
影响因子：
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通讯作者：
Maria Krassilnikova;K. Ostrow;A. Bader;P. Heeger;A. Mehrotra
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文献类型：
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作者：
Maria Krassilnikova;K. Ostrow;A. Bader;P. Heeger;A. Mehrotra
背景本研究的目的是检验维生素D饮食摄入减少导致终末期肾病（ESRD）血液透析（HD）患者维生素D缺乏的假设。方法：我们对来自纽约市西奈山医疗中心（MSMC）附属门诊血液透析单位的58例血液透析门诊患者和MSMC的648例CKD I-IV期门诊患者进行了横断面研究。从2010年8月至2011年7月，在招募的血液透析患者（n=58）中测量血清25（OH）D浓度，并与饮食和生活方式调查结果相关联。西奈山数据仓库（电子病历）用于采集在同一时间段内进行维生素D检测的CKD I-IV期门诊患者的25（OH）维生素D水平。结果HD队列中维生素D不足/缺乏的患病率为96.6%。平均（SD）和中位（IQR）25（OH）D浓度分别为15.65（6.82）和13.55（10.15）ng/mL。膳食调查显示，每周维生素D摄入量中位数为1044 IU（IQR=808，而建议每周摄入量为4200 IU），并特别避免含有维生素D和磷的食物。相比之下，CKD I-IV期患者的平均和中位25（OH）D浓度分别为25.66（13.44）和23.60（15.48）ng/mL（p<0.001 vs. HD患者）。结论：维生素D缺乏症在HD患者中比在CKD透析前患者中更普遍，并且与维生素D的饮食摄入减少有关。为减少膳食磷摄入而实施的透析限制可能会导致ESRD患者维生素D缺乏症的发生。
BACKGROUND The purpose of this study was to test the hypothesis that decreased dietary intake of Vitamin D contributes to Vitamin D deficiency in end-stage renal disease (ESRD) patients on hemodialysis (HD). METHODS We performed a cross-sectional study of 58 hemodialysis outpatients from two Mount Sinai Medical Center (MSMC)-affiliated outpatient HD units in New York City and 648 outpatients at MSMC with CKD stages I-IV. Serum 25(OH)D concentrations were measured from August 2010 to July of 2011 in recruited hemodialysis patients (n=58) and linked with results of dietary and lifestyle surveys. The Mount Sinai Data Warehouse (electronic medical record) was used to capture 25(OH) Vitamin D levels for outpatients with CKD stages I-IV who had Vitamin D testing during the same time period. RESULTS The prevalence of Vitamin D insufficiency/deficiency in the HD cohort was 96.6%. Mean (SD) and median (IQR) 25(OH)D concentrations were 15.65 (6.82) and 13.55 (10.15) ng/mL, respectively. Dietary surveys showed a median weekly Vitamin D intake of 1044 IU (IQR=808, vs. a recommended weekly allowance of 4200 IU) and specific avoidance of foods containing both Vitamin D and phosphorus. In contrast, mean and median 25(OH)D concentrations in patients with CKD stages I-IV were 25.66 (13.44) and 23.60 (15.48) ng/mL (p<0.001 vs. HD patients). CONCLUSIONS Vitamin D deficiency is more prevalent in HD patients than in pre-dialysis patients with CKD and is associated with decreased dietary intake of Vitamin D. Dialysis restrictions imposed to reduce dietary phosphorus intake likely contributes to the development of hypovitaminosis D in ESRD patients.