Improved nutrition, vitamin D use lowers erythropoietin stimulating agent requirements
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KANSAS CITY, Mo. — Erythropoietin stimulating agent use can be reduced with improved nutrition and increased use of vitamin D in patients on hemodialysis, according to results of a study presented at The Annual Dialysis Conference.
“Micronutrient and vitamin D deciency reduces survival, increases cardiovascular mortality, and increases [erythropoietin stimulating agent] ESA usage, as well as cost for hemodialysis patients,” Linda Browning, PhD, MPH, and colleagues from Fresenius Medical Care in Abilene and Lubbock, Texas, wrote. “Clinical practice has lagged behind evidence, [Kidney Disease: Improving Global Outcomes] KDIGO guidelines and policy, as the paradigm of 1,25 renal-activated vitamin D limited to bone mineral metabolism shifts to include non-renal activated vitamin D and micronutrient involvement in erythropoiesis and health.” The research group wanted to show improved nutritional status reduced ESA usage and clinic costs without changing the calcium or phosphorus prescription.
For the study, a retrospective cohort of 77 patients on hemodialysis who completed therapy during 2018 were evaluated by routine clinic measures. In addition, ESA dose, cost and vitamin D25 and B12 use were tracked, along with folate, albumin and hemoglobin. Patients with D25 below 30 ng/mL were prescribed multivitamins along with vitamin D3 or vitamin D3 alone at the physician’s discretion.
Researchers categorized patients into the following four groups:
- patients with renal vitamins and vitamin D3;
- patients with vitamin D2 or D3 only;
- patients with renal vitamins only; and
- patients who were non-adherent to treatment.
“Hypovitaminosis D (<30 ng/mL) was endemic at 80%,” the authors wrote. “The non-adherent group remained decient in all nutrients and required 58% more ESA than those supplemented.” No difference was found in the study groups regarding, age, sex and ethnicity.
The authors noted they were surprised to find the patient group with vitamin D3 alone required 30% more ESA than the vitamin D3 group. The renal vitamins combined with vitamin D3 group had the highest albumin levels.
“Phosphorus and calcium remained stable as vitamin D25 increased,” the authors wrote. “ESA savings for group 1 was $500 per person assuming $1.95/mcg. This savings cost $8 per supplement per month of vitamins and D3.” They added, “Nutritional status can be improved with vitamins and D3, reducing ESA use and costs above D3 alone without compromising calcium or phosphorus.” - by Mark E. Neumann
Reference:
Browning L, et al. Poster #36. Presented at: The Annual Dialysis Conference; Feb. 8-11, 2020; Kansas City; Missouri.
Disclosures: Browning and colleagues reported no relevant financial disclosures.