Dialysis patients need real vitamin D – Editorial
The Many Forms and Functions of Essential Vitamin D for Dialysis Patients
Journal of Renal Nutrition, Volume 23, Issue 4 , Pages e87-e88, July 2013
Caroline Hamatake, MPH, RD [email protected]
Liberty Dialysis–Hawaii, Honolulu, Hawaii
Feature Editor: Catherine M. Goeddeke-Merickel, MS, RD, LD
Introduction/Overview
The screening and treatment of vitamin D deficiency is now routinely done in most dialysis clinics. Many dialysis patients have suboptimal levels of serum 25-hydroxyvitamin D and require vitamin D supplementation even in clinics located in the tropics.
Convincing patients to take a vitamin D supplement has been a challenge, however.
1 Barriers to vitamin D supplementation include confusion about different forms of vitamin D,
2 the lack of knowledge regarding the benefits of adequate vitamin D levels, resistance to an increased daily pill burden, and the potential out-of-pocket cost for “another pill.”
Many patients believe that the vitamin D analog (e.g., oral calcitriol, Hectoral, or Zemplar) they receive in the dialysis clinic is sufficient to address their low serum 25-hydroxyvitamin D level. Their confusion is understandable on the basis of the umbrella term “vitamin D” that is commonly used to refer to the various forms of this hormone-like vitamin in the lay literature and among members of the health team. For example, medical professionals mistakenly tell patients “this is vitamin D” when they administer a vitamin D analog instead of the more accurate “this is an analog of 1,25-dihydroxyvitamin D.”
Requesting patients to add another pill to their daily medication routine is another challenge. In the Transtheoretical Model of Change,3 knowledge of the benefit of a new behavior, or the risk of not adopting a new behavior, empowers a patient to make a behavior change. Therefore, a summary of the benefits of supplemental vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) and the risks associated with low serum 25-hydroxyvitamin D levels 4 would help patients more easily surmount their resistance to an increased pill burden and out-of-pocket costs. However, such a patient-friendly summary of the benefits and risks has not been readily available for patient education.
Thus, a 1-page handout was developed to aid in the education of dialysis patients receiving vitamin D supplementation. (Vitamin D Life was unable to find the PDF)
This patient education handout uses a schematic diagram to illustrate the relationship between the different forms and functions of vitamin D.
Providing additional information such as a list of dietary sources of vitamin D to further explain the difficulty in consuming adequate amounts through food and a list of acceptable vitamin D products available in their respective communities to this 1-page educational handout may be helpful.
Websites
Vitamin D in CKD population:
KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Chapter 4.2: Treatment of abnormal PTH levels in CKD-MBD. Kidney Int. 2009;76(suppl 113):S50-S99. http://www.kdigo.org/guidelines/mbd/guide4.html#chap4.2
KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in CKD, Guideline 7. Prevention and treatment of vitamin D insufficiency and vitamin D deficiency in CKD patients.
General information on vitamin D in health (e.g., functions, dietary sources):
Office of Dietary Supplements, National Institutes of Health. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h3
Linus Pauling Institute. Micronutrient research for optimum health–vitamin D. http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/
List of dietary sources of vitamin D:
- Vitamin D (IU) content of selected foods per common measure, sorted by nutrient content. USDA National Nutrient Database for Standard Reference, Release 25.
References
KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Chapter 4.2: Treatment of abnormal PTH levels in CKD-MBD. Kidney Int. 2009;76(suppl 113):S50–S99
Blair D, Byham-Gray L, Lewis E, McCaffrey S. Prevalence of vitamin D [25(OH)D] deficiency and effects of supplementation with ergocalciferol (vitamin D2) in stage 5 chronic kidney disease patients. J Ren Nutr. 2008;18:375–382
Substance Abuse and Mental Health Services Administration. General information and links on stages of change and motivational interviewing.
- http://www.samhsa.gov/co-occurring/topics/training/change.aspx. Accessed May 13, 2013.
- Joao Matias P, Jorge C, Ferreria C, et al. Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters. Clin J Am Soc Nephrol. 2010;5:905–911
PDF of this article is attached at the bottom of this page
See also Vitamin D Life
Those Dialysis patients with low vitamin D were 75% more likely to die – July 2013 same journal
Hemodialysis not helped by weekly vitamin D2 – RCT April 2015
Dialysis patients with low vitamin D were 2.7 X more likely to die of heart problems – Feb 2011
Dialysis patients with less than 15 ng of vitamin D did not feel well – March 2011