Vitamin D Supplements Help Reduce Need for EPO in Dialysis Patients

Vitamin D Supplements Help Reduce Need for EPO in Dialysis Patients
Steven Fox

December 30, 2010 — Using ergocalciferol (ERGO) vitamin D supplementation in hemodialysis patients deficient in 25-OH vitamin D may decrease the need for erythropoietin (EPO), according to results from a study published in the January/February 2011 issue of the Journal of Nephrology.

Principal author Victoria A. Kumar, MD, from Los Angeles Medical Center in California, and colleagues note that EPO has been a dramatic help in correcting anemia associated with dialysis. However, higher doses also have been linked to an increase in mortality.

"While the specific mechanism for this increase in mortality is not fully understood," the authors write, "efforts to maximize the benefits of EPO at the lowest possible doses should be investigated."

To that end, Dr. Kumar and her group examined the effect of ERGO supplementation — a form of vitamin D2 — on indices of mineral metabolism, anemia, and EPO dose in a pilot study of 81 vitamin D–deficient dialysis patients.

At baseline, mean 25-D levels in study patients were 15.3 ± 7.1 ng/mL. After 4 months of supplementation with ERGO, mean levels had increased to 28.5 ± 8.6 ng/mL, the authors write.

At the beginning of the study, median doses of EPO were 21,933 U/month but dropped to 18,400 U/month after ERGO supplementation.

More than half the patients (57%) required less EPO after ERGO was added to the regimen, whereas the remainder of the patients required a higher dose.

The authors say that mean age, sex, diabetic status, race, and 25-D levels did not differ between patients who responded well to ERGO supplementation and those who did not.

Also unchanged after ERGO was administered were monthly measurements of hemoglobin, iron saturation, albumin, intact parathyroid hormone, calcium, and phosphorous.

The authors note that they were surprised to find that although most of the study patients (94%) showed an increase in 25-D levels after ERGO supplementation, only 44% were able to the achieve what is usually considered the optimal target level for 25-D: 30 ng/mL or greater. That finding was especially surprising, the authors note, because the study participants all resided in southern California, where ample exposure to sunlight is the norm.

One explanation for patients failing to reach optimal levels, the authors note, could be that ERGO supplements were administered from November to February, when outdoor activity would presumably have been less than during other times of the year.

In a previous, similarly designed study (Saab et al. Nephron Clin Pract. 2007;105:c132-c138), 95% of patients were able to achieve vitamin D levels of 30 ng/mL or greater after 300,000 U ERGO were administered during a 6-month period. Patients in that study received their supplements from May to October.

EPO injections are costly, but ERGO supplementation is considerably less so, the authors note. They add that when reimbursements are trimmed, for-profit dialysis centers will likely reduce their use of EPO. That, in turn, may result in significantly lower hemoglobin levels in the United States. "An inexpensive supplement such as ERGO might keep patients out of harm's way in future years, when for-profit units will need to reduce total patient care costs," they conclude.

The study did not receive commercial support. The authors have disclosed no relevant financial relationships.

J Nephrol. 2011;24:98-105. Abstract

http://www.medscape.com/viewarticle/735040