H H CHIN1, Y H CHIN1, Y L YAP1, X T TIONG2, A J MAU CHAI1, C Z CHUA1, V ENG PHUI1, F HUI-SIENG TAN3, C HUI-HONG TAN1
1Department of Nephrology, Sarawak General Hospital, Kuching, Malaysia, 2Clinical Research Centre, Sarawak General Hospital, Kuching, Malaysia, 3Department of Endocrinology, Sarawak General Hospital, Kuching, Malaysia
Aim: To determine factors and outcome associated with Vitamin D deficiency among end stage renal disease (ESRD) patients.
Background: ESRD is associated with increased risk of 25(OH)D deficiency. The other reported risk factors include age, female gender, BMI, diabetes mellitus (DM) and albumin level. Vitamin D status and its association with outcome among dialysis patients in Malaysia is generally unknown.
Methods: Cross sectional study involving maintenance haemodialysis (HD) and peritoneal dialysis (PD) patients. Patients were recruited from November 2015 to September 2016 and followed up till 31 December 2019. Patients were labelled as vitamin D insufficient if 25(OH)D levels were 20-30ng/ml, and deficient if levels were < 20ng/ml. Risk factors for 25(OH)D deficiency and outcomes were assessed using Chi-square test and adjusted using multiple regression analysis.
Results: 170 patients were recruited, 101 on HD and 69 on PD. 49.3% of our PD patients were vitamin deficient compared with only 7.9% among HD patients. As compared to HD patients, PD patients reside mainly in urban areas have higher education level, diuretic usage, shorter dialysis duration, and lower albumin, magnesium level. Multiple logistic regression analysis showed that low serum albumin, phosphate, magnesium level, male gender and DM were significantly associated with 23(OH)D deficiency in our dialysis patients. Chi-square tests showed that patients who were Vitamin D deficient had higher mortality compared to those with 25(OH)D > 20ng/ml (mortality 35.71% vs 13.28%, p=0.001) but there was no difference in relation to Vitamin D treatment or need for parathyroidectomy.
Conclusions: Vitamin D deficiency is highly prevalent among our PD patients and is associated with higher mortality. Vitamin D supplementation in at risk population may improve outcome.
Chin is a budding physician who is passionate in patient’s well-being. He has special interest in nephrology which includes CKD-MBD. He obtained his medical degree in 2013. He served at several hospitals and passed MRCP (UK) in 2019. He is currently attached to Nephrology Department of Sarawak General Hospital, Malaysia.