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Diabetics With Kidney Disease Lack Vitamin D: Presented at ENDO

By Louise Gagnon

TORONTO, CANADA -- June 5, 2007 -- Diabetic patients with chronic kidney disease have insufficient levels of vitamin D compared to their non-diabetic counterparts, both before and after treatment, suggesting increased vitamin D supplementation may be necessary in diabetic patients who have chronic kidney disease.

A retrospective study presented here at a poster session at the 89^th annual meeting of the Endocrine Society (ENDO) examined 274 subjects, consisting of 164 diabetics and 110 non-diabetics. Subjects were aged 18-80, had an estimated GFR of < or equal to 60 ml/min/1.73m²; at least two or more 25-hydroxyvitamin D (25OHD) levels tested 6 to 12 months apart, and were given ergocalciferol supplementation if needed.

The study did not include patients with prior kidney transplant, malignancy, or who were on dialysis. Subjects in the study were matched for factors like age, gender, and ethnicity. Investigators also measured calcium, phosphorus, and parathyroid hormone levels at study entry.

Depletion of 25OHD was defined as less than 30 ng/ml, noted Lina Yassine, MD, first-year endocrinology fellow, Henry Ford Hospital, Detroit, Michigan, United States, and the study's principal investigator.

"We wanted to see if diabetic patients had a lesser response to vitamin D therapy than non-diabetics," said Dr. Yassine. "We checked their 25OHD levels and then they were treated according to KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines. Our results showed patients with diabetes had a lesser response than non-diabetics."

Investigators treated patients with vitamin D supplementation according to the guidelines as published in the American Journal of Kidney Diseases in 2003, said Dr. Yassine.

Specifically, 25OHD levels measured 12 ng/ml in the diabetic population compared to 21 ng/ml in the non-diabetic population prior to therapy (P =.024). After treatment, there was a greater gap in 25OHD levels that was also statistically significant: 19 ng/ml amongst diabetic subjects versus 41 ng/ml amongst non-diabetic patients (P =.017). The mean period between 25OHD levels was 9.2 months.

"Our findings shed light on the fact that we shouldn't ignore 25-hydroxyvitamin D levels in chronic kidney disease patients," said Dr. Yassine. "It's important to check for the levels. Treatment with vitamin D therapy decreases secondary parahypothyroidism and [negative] effects on the bone."

Dr. Yassine said a prospective study should be conducted to assess if increased ergocalciferol supplementation in diabetic patients with chronic kidney disease will raise their levels of 25OHD.

The study was independently conducted.


[Presentation title: Vitamin D Depletion in Chronic Kidney Disease Patients with Diabetes and Response to Vitamin D Therapy. Abstract P1-118]

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