Nutr Res Pract.  2015 Apr;9(2):158-164. 10.4162/nrp.2015.9.2.158.

Effects of sun exposure and dietary vitamin D intake on serum 25-hydroxyvitamin D status in hemodialysis patients

Affiliations
  • 1Department of Food and Nutrition, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea. leess@hanyang.ac.kr
  • 2Department of Nephrology, Hanyang University Seoul Hospital, Seoul 133-792, Korea.
  • 3Department of Nutrition, Hanyang University Seoul Hospital, Seoul 133-792, Korea.

Abstract

BACKGROUND/OBJECTIVES
Vitamin D deficiency is common in hemodialysis patients. The aim of this study was to identify whether or not sun exposure and dietary vitamin D intake have effects on serum 25-hydroxyvitamin D (25(OH)D) status in hemodialysis (HD) patients. The objective was to identify the main determinants of serum vitamin D status in the study subjects.
SUBJECTS/METHODS
A cross-sectional study of 47 HD patients (19 males and 28 females) was performed. We assessed serum 25(OH)D and 1,25(OH)2D levels between August and September 2012 and analyzed the prevalence of vitamin D deficiency in HD patients. To evaluate the determinants of serum 25(OH)D levels, we surveyed dietary vitamin D intake, degree of sun exposure, and outdoor activities. To compare biological variables, serum 25(OH)D was stratified as below 15 ng/ml or above 15 ng/ml.
RESULTS
Mean 25(OH)D and 1,25(OH)2D levels were 13.5 +/- 5.8 ng/ml and 20.6 +/- 11.8 pg/ml, respectively. The proportions of serum 25(OH)D deficiency (< 15 ng/ml), insufficiency (15-< 30 ng/ml), and sufficiency (> or = 30 ng/ml) in subjects were 72.4%, 23.4%, and 4.3%, respectively. Prevalence of vitamin D deficiency in female patients was 78.6%, whereas that in males was 63.2% (P = 0.046). Vitamin D intake and sun exposure time were not significantly different between the two stratified serum 25(OH)D levels. Dietary intake of vitamin D did not contribute to increased serum 25(OH)D levels in HD patients. The main effective factors affecting serum 25(OH)D status were found to be the sun exposure and active outdoor exercise.
CONCLUSIONS
Hypovitaminosis D is common in HD patients and is higher in females than in males. Sun exposure is the most important determinant of serum 25(OH)D status in HD patients.

Keyword

Hemodialysis; 25-hydroxyvitamin D; sun-exposure; hypovitaminosis D

MeSH Terms

Cross-Sectional Studies
Female
Humans
Male
Prevalence
Renal Dialysis*
Solar System*
Vitamin D Deficiency
Vitamin D*
Vitamin D

Reference

1. Lee YM, Park SW, Kim JS, Wang JK, Kim JY, Park MS, Pyo HJ, Kwon YJ. 25-Hydroxyvitamin D status in patients with chronic kidney disease in a single center. Korean J Nephrol. 2010; 29:458–464.
2. Nykjaer A, Dragun D, Walther D, Vorum H, Jacobsen C, Herz J, Melsen F, Christensen EI, Willnow TE. An endocytic pathway essential for renal uptake and activation of the steroid 25-(OH) vitamin D3. Cell. 1999; 96:507–515.
Article
3. Liu W, Yu WR, Carling T, Juhlin C, Rastad J, Ridefelt P, Akerström G, Hellman P. Regulation of gp330/megalin expression by vitamins A and D. Eur J Clin Invest. 1998; 28:100–107.
Article
4. Kim CS, Kim SW. Vitamin D and chronic kidney disease. Korean J Intern Med. 2014; 29:416–427.
Article
5. Ramos R, Alcázar R, Otero A, de Francisco AL, del Pino MD. Economic impact of vitamin D treatment on chronic kidney disease patients. Nefrologia. 2011; 31:528–536.
6. Dusso A, González EA, Martin KJ. Vitamin D in chronic kidney disease. Best Pract Res Clin Endocrinol Metab. 2011; 25:647–655.
Article
7. Hsu CH, Patel S. Uremic plasma contains factors inhibiting 1 alpha-hydroxylase activity. J Am Soc Nephrol. 1992; 3:947–952.
Article
8. Krassilnikova M, Ostrow K, Bader A, Heeger P, Mehrotra A. Low dietary intake of vitamin D and vitamin D deficiency in hemodialysis patients. J Nephrol Ther. 2014; 4:pii: 166.
Article
9. Mehrotra R, Kermah D, Budoff M, Salusky IB, Mao SS, Gao YL, Takasu J, Adler S, Norris K. Hypovitaminosis D in chronic kidney disease. Clin J Am Soc Nephrol. 2008; 3:1144–1151.
Article
10. Judd SE, Tangpricha V. Vitamin D therapy and cardiovascular health. Curr Hypertens Rep. 2011; 13:187–191.
Article
11. Sterling KA, Eftekhari P, Girndt M, Kimmel PL, Raj DS. The immunoregulatory function of vitamin D: implications in chronic kidney disease. Nat Rev Nephrol. 2012; 8:403–412.
Article
12. Pilz S, Iodice S, Zittermann A, Grant WB, Gandini S. Vitamin D status and mortality risk in CKD: a meta-analysis of prospective studies. Am J Kidney Dis. 2011; 58:374–382.
Article
13. Duranton F, Rodriguez-Ortiz ME, Duny Y, Rodriguez M, Daurès JP, Argilés A. Vitamin D treatment and mortality in chronic kidney disease: a systematic review and meta-analysis. Am J Nephrol. 2013; 37:239–248.
Article
14. Navaneethan SD, Schold JD, Arrigain S, Jolly SE, Jain A, Schreiber MJ Jr, Simon JF, Srinivas TR, Nally JV Jr. Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. Am J Kidney Dis. 2011; 58:536–543.
Article
15. Kendrick J, Cheung AK, Kaufman JS, Greene T, Roberts WL, Smits G, Chonchol M. HOST (Homocysteinemia in Kidney and End Stage Renal Disease) Study Investigators. Associations of plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations with death and progression to maintenance dialysis in patients with advanced kidney disease. Am J Kidney Dis. 2012; 60:567–575.
Article
16. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42:S1–S201.
17. Kim SM, Choi HJ, Lee JP, Kim DK, Oh YK, Kim YS, Lim CS. Prevalence of vitamin D deficiency and effects of supplementation with cholecalciferol in patients with chronic kidney disease. J Ren Nutr. 2014; 24:20–25.
Article
18. Descombes E, Fellay B, Hemett OM, Magnin JL, Fellay G. Oral postdialysis cholecalciferol supplementation in patients on maintenance hemodialysis: a dose-response approach. Int J Nephrol. 2014; 2014:597429.
Article
19. Mose FH, Vase H, Larsen T, Kancir AS, Kosierkiewic R, Jonczy B, Hansen AB, Oczachowska-Kulik AE, Thomsen IM, Bech JN, Pedersen EB. Cardiovascular effects of cholecalciferol treatment in dialysis patients--a randomized controlled trial. BMC Nephrol. 2014; 15:50.
20. Tolouian R, Rao DS, Goggins M, Bhat S, Gupta A. Seasonal variation of vitamin D in patients on hemodialysis. Clin Nephrol. 2010; 74:19–24.
Article
21. Chang JH, Ro H, Kim S, Lee HH, Chung W, Jung JY. Study on the relationship between serum 25-hydroxyvitamin D levels and vascular calcification in hemodialysis patients with consideration of seasonal variation in vitamin D levels. Atherosclerosis. 2012; 220:563–568.
Article
22. Yu A, Kim J, Kwon O, Oh SY, Kim J, Yang YJ. The association between serum 25-hydroxyvitamin D concentration and consumption frequencies of vitamin D food sources in Korean adolescents. Clin Nutr Res. 2013; 2:107–114.
Article
23. Hur SJ, Kim DM, Lim KH, Yoon SH, Chung HC, Lee JS, Park J. Vitamin D levels and their relationship with cardiac biomarkers in chronic hemodialysis patients. J Korean Med Sci. 2009; 24:Suppl. S109–S114.
Article
24. Del Valle E, Negri AL, Aguirre C, Fradinger E, Zanchetta JR. Prevalence of 25(OH) vitamin D insufficiency and deficiency in chronic kidney disease stage 5 patients on hemodialysis. Hemodial Int. 2007; 11:315–321.
Article
25. Matias PJ, Ferreira C, Jorge C, Borges M, Aires I, Amaral T, Gil C, Cortez J, Ferreira A. 25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients. Nephrol Dial Transplant. 2009; 24:611–618.
Article
26. Figuiredo-Dias V, Cuppari L, Garcia-Lopes MG, de Carvalho AB, Draibe SA, Kamimura MA. Risk factors for hypovitaminosis D in nondialyzed chronic kidney disease patients. J Ren Nutr. 2012; 22:4–11.
Article
27. Park YK, Lee YJ, Lee SS. The intake of food and nutrient by the elderly with chronic disease in the Seoul area. Korean J Nutr. 2012; 45:531–540.
Article
28. Burgaz A, Akesson A, Oster A, Michaëlsson K, Wolk A. Associations of diet, supplement use, and ultraviolet B radiation exposure with vitamin D status in Swedish women during winter. Am J Clin Nutr. 2007; 86:1399–1404.
Article
29. Russo R, Ruospo M, Cozzolino M, De Nicola L, Icardi A, Paoletti E, Mazzaferro S. Effects of vitamin D on parathyroid hormone and clinical outcomes in peritoneal dialysis: a narrative review. J Nephrol. 2014; 27:483–494.
Article
30. Coyne DW, Goldberg S, Faber M, Ghossein C, Sprague SM. A randomized multicenter trial of paricalcitol versus calcitriol for secondary hyperparathyroidism in stages 3-4 CKD. Clin J Am Soc Nephrol. 2014; 9:1620–1626.
Article
31. Lee YH, Kim JE, Roh YH, Choi HR, Rhee Y, Kang DR, Lim SK. The combination of vitamin D deficiency and mild to moderate chronic kidney disease is associated with low bone mineral density and deteriorated femoral microarchitecture: results from the KNHANES 2008-2011. J Clin Endocrinol Metab. 2014; 99:3879–3888.
Article
32. Gruson D, Buglioni A, Burnett JC Jr. PTH: Potential role in management of heart failure. Clin Chim Acta. 2014; 433:290–296.
Article
33. Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ, Strippoli GF. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. JAMA. 2011; 305:1119–1127.
Article
34. Anderson JL, Vanwoerkom RC, Horne BD, Bair TL, May HT, Lappé DL, Muhlestein JB. Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease: dependent or independent risk factors? Am Heart J. 2011; 162:331–339.e2.
Article
35. Kestenbaum B, Katz R, de Boer I, Hoofnagle A, Sarnak MJ, Shlipak MG, Jenny NS, Siscovick DS. Vitamin D, parathyroid hormone, and cardiovascular events among older adults. J Am Coll Cardiol. 2011; 58:1433–1441.
Article
36. Elder GJ. Vitamin D levels, bone turnover and bone mineral density show seasonal variation in patients with chronic kidney disease stage 5. Nephrology (Carlton). 2007; 12:90–94.
37. Farrar MD, Webb AR, Kift R, Durkin MT, Allan D, Herbert A, Berry JL, Rhodes LE. Efficacy of a dose range of simulated sunlight exposures in raising vitamin D status in south Asian adults: implications for targeted guidance on sun exposure. Am J Clin Nutr. 2013; 97:1210–1216.
Article
Full Text Links
  • NRP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr