Nand N, Mittal R
Senior Professor and Unit Head.
Resident, Department of Medicine, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana.
J Assoc Physicians India. 2017 Feb;65(2):38-42.
The role of vitamin D deficiency and inflammation levels in renal anemia has been documented. However, no study is available in India where the role of vitamin D supplementation in patients with hyporesponsiveness to increased doses of erythropoietin is available. Hence this study.
This study was conducted on 50 adult patients of CKD, on regular, twice weekly hemodialysis. It included 38 cases in group A with deficient serum vitamin D levels (<30 ng/ml) and 12 cases in group B with sufficient vitamin D levels (>30 ng/ml). Both groups of cases were receiving erythropoietin in a dose of 4000 I.U. subcutaneously twice weekly following dialysis and had failed to show rise in hemoglobin (Hb) >1gm/dl after one month, hence erythropoietin was increased to 6000 I.U. Group A was given additional vitamin D in a dose of 60000 I.U. orally, once a week for next three months along with erythropoietin 6000 I.U. where as Group B served as control. Hematological and renal parameters, ESR, high sensitivity C reactive protein (HsCRP) and serum ferritin were estimated at baseline and then at one monthly intervals for next four months. Parathyroid hormone (iPTH), serum B12, folic acid and vitamin D (25OHD3) were measured at the start and end of the study only. Erythropoietin resistance index (ERI) was calculated to evaluate dose response.
Basal ERI, HsCRP and ESR and serum ferritin were raised in both the groups. At the end of four months, there was a significant increase in the Hb and hematocrit (Hct) (p<.001) and a significant fall in ERI, ESR, HsCRP, serum ferritin and iPTH (p<.001) in group A. Group B, also had a significant increase in the hemoglobin and hematocrit (p<.001) and decrease in ERI, ESR, HsCRP, serum ferritin and iPTH which was not significant. Basal vitamin D and ERI had a positive and insignificant correlation (r=0.05; p=0.756) in group A where as a negative and insignificant correlation was observed between them at the end of four months (r= -0.195; p >0.05).
vitamin D play an important role in reducing inflammation and thereby in the cure of anemia in EPO hyporesponsive CKD patients and needs to be supplemented, if deficiency is found.
维生素D缺乏和炎症水平在肾性贫血中的作用已有文献记载。然而，在印度尚无关于维生素D补充剂对促红细胞生成素剂量增加反应低下患者作用的研究。因此开展了本研究。
本研究对50例成年慢性肾脏病患者进行，这些患者定期每周进行两次血液透析。其中A组38例血清维生素D水平不足（<30 ng/ml），B组12例血清维生素D水平充足（>30 ng/ml）。两组患者均在每次透析后皮下注射4000国际单位促红细胞生成素，每周两次，且在1个月后血红蛋白（Hb）升高未超过1 g/dl，因此将促红细胞生成素剂量增至6000国际单位。A组在接下来的三个月中，每周口服一次60000国际单位的额外维生素D，同时注射6000国际单位促红细胞生成素，而B组作为对照。在基线时以及接下来的四个月中每月评估血液学和肾脏参数、血沉（ESR）、高敏C反应蛋白（HsCRP）和血清铁蛋白。仅在研究开始和结束时测量甲状旁腺激素（iPTH）、血清维生素B12、叶酸和维生素D（25OHD3）。计算促红细胞生成素抵抗指数（ERI）以评估剂量反应。
两组患者的基础ERI、HsCRP、ESR和血清铁蛋白均升高。四个月结束时，A组患者的血红蛋白和血细胞比容（Hct）显著升高（p<0.001），ERI、ESR、HsCRP、血清铁蛋白和iPTH显著下降（p<0.001）。B组患者的血红蛋白和血细胞比容也显著升高（p<0.001），ERI、ESR、HsCRP、血清铁蛋白和iPTH下降，但差异不显著。A组患者基础维生素D与ERI呈正相关但不显著（r=0.05；p=0.756），而在四个月结束时二者呈负相关但不显著（r= -0.195；p>0.05）。
维生素D在减轻炎症从而治疗促红细胞生成素反应低下的慢性肾脏病患者贫血方面发挥重要作用，若发现维生素D缺乏则需要进行补充。
