| | SLO | ENG | Cookies and privacy

Bigger font | Smaller font
First page > Show document

Show document Help

Title:Pomanjkanje vitamina D pri bolnikih zdrhttp://dkum.uni-mb.si/Dokument.php?id=56194avljenih s kronično hemodializo in njegovo nadomeščanje z visokimi odmerki holekalciferola
Authors:ID Jakopin, Eva (Author)
ID Pečovnik Balon, Breda (Mentor) More about this mentor... New window
Files:.pdf DR_Jakopin_Eva_2013.pdf (2,73 MB)
MD5: 4E8E453FDE6C7F5BA11619EEF2FC2C62
 
Language:Slovenian
Work type:Dissertation
Organization:MF - Faculty of Medicine
Abstract:Uvod Pogost zaplet kronične ledvične bolezni (KLB) je mineralna in kostna ledvična bolezen (KLB-MKB), v sklopu te pa pomanjkanje vitamina D. Vzroki so hiperfosfatemija, hipokalcemija ter zmanjšano ledvično nastajanje aktivnega vitamina D. Vitamin D vpliva na kostno-mineralni metabolizem, deluje protivnetno, protitumorsko, zavira avtoimunske bolezni, srčnožilne bolezni, sladkorno bolezen, itd. Za hemodializne (HD) bolnike pomanjkanje vitamina D dokazano predstavlja višje tveganje za celokupno umrljivost. Zaenkrat obstajajo le priporočila Kidney Disease Outcomes Quality Initiative (K/DOQI) za nadomeščanje vitamina D pri bolnikih s KLB stopnje 3 in 4. Glede na prisotnost izvenledvične hidroksilaze se priporoča nadomeščanje z visokimi odmerki neaktivnih oblik. Cilji Glede na dokazano višjo umrljivost pri pomanjkanju vitamina D pri HD bolnikih in odsotnost uradnih priporočil za nadomeščanje, smo se odločili za raziskavo na podlagi katere bi izdelali svoj protokol nadomeščanja. Bolniki in metode Prospektivna raziskava je potekala od maja 2008 do maja 2010 v dializnem centru Univerzitetnega kliničnega centra Maribor. Bolnikom smo v začetku raziskave in nato vsake 4 mesece določali vrednost 25-hidroksivitamina D (25(OH)D), intaktnega parathormona (iPTH), kalcija (Ca) in fosfata (P). Bolniki z vrednostjo 25(OH)D < 75 nmol/L so enkrat mesečno prejeli 40.000 IE holekalciferola per os (Plivit D3®) 3 mesece zaporedoma. Ob kontrolah smo pri bolnikih s 25(OH)D < 75 nmol/L zdravljenje nadaljevali, pri 25(OH)D > 75 nmol/L pa smo zdravljenje do naslednje kontrole prekinili. Rezultati Od 101 bolnikov je bilo 52 (51,5%) moških in 49 (48,5%) žensk, starih 63,3 ± 13,5 let. Ob začetku raziskave so bili s HD zdravljeni v povprečju 69,1 ± 66,5 mesecev. Izgubili smo 36 (35,6%) bolnikov: 16 (44,4%) jih je umrlo, 11 (30,6%) je imelo presajeno ledvico, 9 (25%) je zamenjalo dializni center. Na začetku raziskave so 3 (3,0%) imeli zadostne zaloge vitamina D, 29 (28,7%) nezadostne, 52 (51,5%) blago pomanjkanje in 17 (16,8%) hudo pomanjkanje. Moški so imeli statistično značilno višjo začetno vrednost 25(OH)D kot ženske (p = 0,007). Bolniki mlajši od 67 let so imeli statistično značilno višjo začetno vrednost 25(OH)D kot starejši (p < 0,001). Med skupinami ni bilo razlik v končnih vrednostih 25(OH)D. Ob koncu raziskave je imelo 50 bolnikov (76,9%) nezadostno vrednost 25(OH)D, 9 (13,8%) blago pomanjkanje in 6 (9,2%) zadostne zaloge. Od prvega ciklusa zdravljenja ni bilo več bolnikov s hudim pomanjkanjem. Povprečna vrednost Ca se je med raziskavo znižala iz 2,28 ± 0,14 mmol/L na 2,16 ± 0,17 mmol/L (p < 0,001), povprečna vrednost 25(OH)D pa zvišala iz 28,6 ± 16,7 mmol/L na 54,9 ± 15,5 nmol/L (p < 0,001). Nismo ugotavljali statistično značilnih sprememb v koncentracijah iPTH in P. Bolniki, ki so raziskavo zaključili (n = 65), so v povprečju prejeli 12,9 ± 3,9 (mediana 12) odmerkov holekalciferola. Od tega je 29,2% (n = 19) bolnikov prejelo 12 odmerkov, 24,6% (n = 16) bolnikov 15 odmerkov, 21,5% (n = 14) bolnikov 18 odmerkov, 13,8% (n = 9) 6 odmerkov in 10,8% (n = 7) bolnikov je prejelo 9 odmerkov holekalciferola. Povprečno število prejetih odmerkov je koreliralo z začetno koncentracijo 25(OH)D (p = 0,041; korelacijski koeficient – 0,255). Tudi bolnik z zadostno začetno koncentracijo 25(OH)D je za vzdrževanje potreboval 6 odmerkov holekalciferola. Bolniki z nezadostnimi začetnimi koncentracijami 25(OH)D (n = 17) so potrebovali 12,5 ± 3,6 odmerkov (mediana 12 odmerkov) holekalciferola. Bolniki z blagim pomanjkanjem (n = 36) so potrebovali 13,2 ± 3,7 odmerka (mediana 12 odmerkov). Bolniki s hudim pomanjkanjem 25(OH)D (n = 11) so potrebovali 13,1 ± 4,9 odmerkov (mediana 15 odmerkov). Bolniki so zdravljenje s holekalciferolom dobro prenašali. V začetku raziskave noben bolnik ni imel hiperkalcemije, 25 bolnikov (24,8%) pa je imelo hiperfosfatemijo z najvišjo vrednostjo P 2,69 mmol/L. Po 24 mesecih je bil le 1 (1,5%) bolnik hiperkalcemičen s Ca 2,73 mmol/L in osem b
Keywords:hemodializa, holekalciferol, nadomeščanje vitamina D, pomanjkanje vitamina D, 25-hidroksivitamin D
Place of publishing:Maribor
Year of publishing:2013
PID:20.500.12556/DKUM-40891 New window
COBISS.SI-ID:267459584 New window
NUK URN:URN:SI:UM:DK:QW7SEXOO
Publication date in DKUM:03.07.2013
Views:4072
Downloads:427
Metadata:XML DC-XML DC-RDF
Categories:MF
:
Copy citation
  
Average score:(0 votes)
Your score:Voting is allowed only for logged in users.
Share:Bookmark and Share



Hover the mouse pointer over a document title to show the abstract or click on the title to get all document metadata.

Secondary language

Language:English
Title:High-dose cholecalciferol supplementation for vitamin D deficiency in haemodialysis patients
Abstract:Introduction Mineral and bone disorders (CKD-MBD) accompany chronic kidney disease (CKD) often. They are associated with vitamin D deficiency which is caused by hyperphosphatemia, hypocalcaemia and decreased renal production of active forms of vitamin D. Actions of vitamin D effect bone and mineral metabolism, it acts anti-inflammatory, anti-proliferative, it inhibits autoimmune diseases, cardiovascular diseases, diabetes, etc.. Studies have shown higher mortality rates in haemodialysis (HD) patients with vitamin D deficiency. So far there are Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines available for vitamin D supplementation in predialysis patients only. Due to extra-renal hydroxylase, supplementation with high-doses of inactive forms of vitamin D is recommended. Aims Higher mortality in vitamin D deficient HD patients and the absence of formal recommendations for the replacement prompted us to perform a study to develop a vitamin D replacement protocol in HD patients. Patients and methods A prospective study was conducted from May 2008 to May 2010 in the dialysis center at the University Medical Centre Maribor. 25-hydroxyvitamin D (25 (OH) D), intact parathormone (iPTH), calcium (Ca) and phosphorus (P) concentrations were determined in the beginning of the study and then every 4 months. Patients with 25 (OH) D concentration <75 nmol / L received 40,000 IU of oral cholecalciferol (Plivit D3 ®) monthly 3 months in a row. Treatment was continued until 25 (OH) D concentration reached 75 nmol / L, when it was discontinued until next measurement. Results Of the 101 patients 52 (51.5%) were men and 49 (48.5%) women, aged 63.3 ± 13.5 years. The duration of HD at the beginning of the study was on average 69.1 ± 66.5 months. 36 (35.6%) patients were lost in follow-up: 16 (44.4%) died, 11 (30.6%) had a kidney transplantation, 9 (25%) were transferred to another dialysis center. At the beginning 3 (3.0%) patients had sufficient vitamin D stores, 29 (28.7%) insufficient ,52 (51.5%) mildly deficient and 17 (16.8%) severely deficient. Men had significantly higher baseline 25 (OH) D than women (p = 0.007). Patients younger than 67 years had significantly higher baseline 25 (OH) D than older (p <0.001). There was no difference in the final values of 25 (OH) D. At the end of the study 50 patients (76.9%) were vitamin D insufficient, 9 (13.8%) mildly deficient and 6 (9.2%) had sufficient vitamin D stores. After completion of first cycle of treatment no patient was ever found to be severly defecient. During the study, there were no significant changes in the levels of iPTH and P. Mean level of Ca decreased from 2,28 ± 0,14 mmol/L to 2,16 ± 0,17 mmol/L (p < 0,001), mean level of 25(OH)D increased from 28,6 ± 16,7 mmol/L to 54,9 ± 15,5 nmol/L (p < 0,001). Patients who completed the study (n = 65) had on average received 12.9 ± 3.9 (median 12) doses of cholecalciferol. 29.2% (n = 19), patients received 12 doses, 24.6% (n = 16) patients received 15 doses, 21.5% (n = 14) patients received 18 doses, 13.8% (n = 9) patients recieved 6 doses and 10.8% (n = 7) patients received 9 doses of cholecalciferol. A correlation existed between baseline 25(OH)D concentration and a mean number of doses. (p = 0,041; correlation coeficient – 0,255). Even the only patient with sufficient baseline 25(OH)D level needed 6 doses of cholecalciferol just for maintenance. Patients with insufficient baseline 25(OH)D levels (n = 17) needed a mean of 12,5 ± 3,6 (median 12) doses of cholecalciferol. Patients with mildly deficient baseline 25(OH)D levels (n = 36) needed a mean of 13,2 ± 3,7 (median 12) doses of cholecalciferol. Patients with severly deficient baseline 25(OH)D levels (n = 11) needed a mean of 13,1 ± 4,9 (median 15) doses of cholecalciferol. Treatment with cholecalciferol was well tolerated. At baseline, no patients were hypercalcaemic and 25 (24.8%) were hyperphosphataemic with a maximum P level of 2.69 mmol/l. After 24 months, only one (1.5%) patient was hypercalcaemic with a maximum Ca level of 2
Keywords:haemodialysis, cholecalciferol, vitamin D supplementation, vitamin D deficiency, 25-hydroxyvitamin D


Comments

Leave comment

You must log in to leave a comment.

Comments (0)
0 - 0 / 0
 
There are no comments!

Back
Logos of partners University of Maribor University of Ljubljana University of Primorska University of Nova Gorica