Vitamin D Deficiency Likely Among Many Patients Starting Dialysis Laurie Barclay, MD March 1, 2010 Vitamin D deficiency is almost

t universal in patients with kidney disease with low blood albumin levels who begin long-term dialysis during the winter, according to the results of a study reported in the March issue of the Clinical Journal of the American Society of Nephrology. "This research identifies risk factors for nutritional vitamin D deficiency in the dialysis population and may provide clues to its biology in this population," lead author Ishir Bhan, MD, MPH, from Massachusetts General Hospital in Boston, said in a news release. The goal of this study was to examine whether routinely measured clinical and demographic factors could identify patients starting dialysis who are deficient in vitamin D. The study cohort, which was divided into training (60%) and validation (40%) sets, consisted of 908 patients with 25-hydroxyvitamin D levels who were enrolled in the Accelerated Mortality on Renal Replacement (ArMORR) cohort of incident US patients initiating dial ysis. Using logistic regression modeling, neural networks, and decision trees with vitamin D deficiency as the dependent variable, the investigators generated predictive models from routinely determined clinical and demographic data in the training set. To identify the simplest model that remained predictive, the investigators subjected the models to progressive variable reduction. Vitamin D deficiency, defined as 25-hydroxyvitamin D levels of less than 30 ng/mL, was present in 79% of the study population. The strongest predictors of vitamin D deficiency were black race, female sex, winter season, and hypoalbuminemia (serum albumin levels 3.1 g/dL). In the validation set, factors of hypoalbuminemia and dialysis started during the winter season increased the likelihood of vitamin D deficiency from 90% to 100% in black women, from 85% to 100% in black men, from 82% to 94% in white women, and from 66% to 92% in white men. "Deficiency of 25-hydroxyvitamin D is nearly universal among patients with hypoalbuminemia initiating chronic hemodialysis in winter," the study authors write. Limitations of this study include lack of generalizability to non-US populations, uncertain direction of causality, and possible residual confounding. In addition, further studies are needed to determine if repleting 25-hydroxyvitamin D levels affect hyperglycemia, blood pressure, infection rates, or mortality rates in end-stage renal disease (ESRD). "Although this study identified clinical factors that predicted low 25-hydroxyvitamin D levels, it is not yet proven that correcting these levels is clinically beneficial," the study authors conclude. "Prospective studies in ESRD, some of which are now underway, are needed to identify optimal levels of 25-hydroxyvitamin D for a range of functions and to further elucidate its biology. In the absence of clinical trials, clinicians must independently determine if these findings should guide empiric therapy or simply inform future studies." Some of the study authors have disclosed various financial relationships with the National Kidney Foundation, the National Institutes of Health, and/or Abbott Laboratories. Clin J Am Soc Nephrol. 2010;5:460-467. Reference: http://medscape.com

Summary: The journal is about nutritional deficiencies common and inevitable in patients undergoing dialysis. A research conducted in US found out that vitamin D is one of the nutrients commonly spared under clinical procedures. Some of the predisposing factors to vitamin deficiency are a clients race, gender, climate and low serum albumin levels (hypoalbuminemia). Although this research is not yet finished and still going under study, they are investigating whether Vitamin D depletion really affect or somehow related to hyperglycemia, blood pressure, infection rates, or mortality rates in end-stage renal disease (ESRD). Further studies are being conducted on vitamin D and if levels are corrected that can it be beneficial to the prognosis of the clients condition. Nursing Implications: Vitamin D deficiency can occur for a number of reasons. Your kidneys may have problems converting vitamin D to its active form. As people age their kidneys are less able to convert vitamin D to its active form, thus increasing their risk of vitamin D deficiency. Vitamin D is essential for strong bones because it helps the body use calcium from the diet. Traditionally, vitamin D deficiency has been associated with rickets, a disease in which the bone tissue doesn't properly mineralize, leading to soft bones and skeletal deformities. Research suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including type1 and type 2 diabetes, hypertension and glucose intolerance. Indeed, nutrition is also included in our priorities. Good sources of vitamin D are milk and sunlight exposure. Though ERSD patients were restricted to fluids, we just dont want them to develop bone problems in the future so I really found my topic significant. But more than that, we have to see and not underestimate the importance of vitamin D in protecting against a host of health problems.

Significance of study in nursing profession: Nurses are significant part of a patients support system. We are indeed privileged to get involved in the process of peoples recovery. The idea of caring for ERSD patients means we definitely share an active and big participation in the lives of our patients. Man really advanced over time: saving, lengthening and changing lives. Surely these people will have a story to tell. With Faith and the technologies man invented, its proven enough that all impossible things can be possible. We must carry out our jobs and responsibilities as their nurses for we are liable to their health. We must learn to deal with each cases and situations faced to us. In fact, we are the ones who should best understand our patients and show our genuine care. We are part of their support system. Reaction: I know how it breaks a persons heart to know that your days are numbered on earth. Our clients pain is our own pain too. We must put our feet on their shoes. Everyone desires to live a comfortable life, a lifestyle of happiness and ease. Kidney complications are definitely not something they wished or wanted. As a student nurse, it opened my eyes that not all therapies turns out good. We shouldnt be the first ones to be emotional. Neither our clients expect us to sympathize. Rather, we must stay strong in the midst of hurricanes and convince them to trust us the rest. Caring can never be authentic care without a nurses true passionate heart to serve. We put heart and dedication in every single care we provide. Only by then, we see a difference that in our little ways, truly we have touched and left mark on patients lives. Eden Kaith F. Dimailig, S.N 3-A, Group 2B