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Vitamin D and Anemia in Chronic Kidney Disease

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Vitamin D in Chronic Kidney Disease

Abstract

A considerable proportion of patients with chronic kidney disease develop anemia. Several factors are known to contribute to this renal anemia, like EPO deficiency, EPO hyporesponsiveness and functional iron deficiency due to increasing concentrations of hepcidin. Recent studies showing an association in abnormalities of the vitamin D system with low hemoglobin (Hb) levels and erythropoietin stimulating agent (ESA) resistance suggest cross-talk between the vitamin D system and erythropoiesis. The administration of either inactive or active vitamin D has been associated with an improvement of anemia and reduction in EPO hyporesponsiveness. Potential links between the vitamin D system and erythropoiesis are described in this chapter.

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References

  1. McClellan W, Aronoff SL, Bolton WK, Hood S, Lorber DL, Tang KL, et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin. 2004;20(9):1501–10.

    Article  PubMed  Google Scholar 

  2. Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis. 1999;34(1):125–34.

    Article  CAS  PubMed  Google Scholar 

  3. Sarnak MJ, Tighiouart H, Manjunath G, Macleod B, Griffith J, Salem D, et al. Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol. 2002;40(1):27–33.

    Article  PubMed  Google Scholar 

  4. McClellan WM, Flanders WD, Langston RD, Jurkovitz C, Presley R. Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol. 2002;13(7):1928–36.

    Article  PubMed  Google Scholar 

  5. Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int. 2007;72(8):1004–13.

    Article  CAS  PubMed  Google Scholar 

  6. Matias PJ, Ferreira C, Jorge C, Borges M, Aires I, Amaral T, et al. 25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients. Nephrol Dial Transplant. 2009;24(2):611–8.

    Article  CAS  PubMed  Google Scholar 

  7. Kiss Z, Ambrus C, Almasi C, Berta K, Deak G, Horonyi P, et al. Serum 25(OH)-cholecalciferol concentration is associated with hemoglobin level and erythropoietin resistance in patients on maintenance hemodialysis. Nephron Clin Pract. 2011;117(4):c373–8.

    Article  CAS  PubMed  Google Scholar 

  8. Patel NM, Gutierrez OM, Andress DL, Coyne DW, Levin A, Wolf M. Vitamin D deficiency and anemia in early chronic kidney disease. Kidney Int. 2010;77(8):715–20.

    Article  CAS  PubMed  Google Scholar 

  9. Carvalho C, Isakova T, Collerone G, Olbina G, Wolf M, Westerman M, et al. Hepcidin and disordered mineral metabolism in chronic kidney disease. Clin Nephrol. 2011;76(2):90–8.

    Article  CAS  PubMed  Google Scholar 

  10. Perlstein TS, Pande R, Berliner N, Vanasse GJ. Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation. Blood. 2011;117(10):2800–6.

    Article  CAS  PubMed  Google Scholar 

  11. Bacchetta J, Zaritsky JJ, Sea JL, Chun RF, Lisse TS, Zavala K, et al. Suppression of iron-regulatory hepcidin by vitamin D. J Am Soc Nephrol. 2014;25(3):564–72.

    Article  CAS  PubMed  Google Scholar 

  12. Zughaier SM, Alvarez JA, Sloan JH, Konrad RJ, Tangpricha V. The role of vitamin D in regulating the iron-hepcidin-ferroportin axis in monocytes. J Clin Transl Endocrinol. 2014;1(1):19–25.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Aucella F, Scalzulli RP, Gatta G, Vigilante M, Carella AM, Stallone C. Calcitriol increases burst-forming unit-erythroid proliferation in chronic renal failure. A synergistic effect with r-HuEpo. Nephron Clin Pract. 2003;95(4):c121–7.

    Article  CAS  PubMed  Google Scholar 

  14. Wong MS, Leisegang MS, Kruse C, Vogel J, Schurmann C, Dehne N, et al. Vitamin D promotes vascular regeneration. Circulation. 2014;130(12):976–86.

    Article  CAS  PubMed  Google Scholar 

  15. Besarab A, Chernyavskaya E, Motylev I, Shutov E, Kumbar LM, Gurevich K, et al. Roxadustat (FG-4592): correction of anemia in incident dialysis patients. J Am Soc Nephrol. 2016;27:1225–33.

    Google Scholar 

  16. Ben-Shoshan M, Amir S, Dang DT, Dang LH, Weisman Y, Mabjeesh NJ. 1alpha,25-dihydroxyvitamin D3 (Calcitriol) inhibits hypoxia-inducible factor-1/vascular endothelial growth factor pathway in human cancer cells. Mol Cancer Ther. 2007;6(4):1433–9.

    Article  CAS  PubMed  Google Scholar 

  17. Peyssonnaux C, Zinkernagel AS, Schuepbach RA, Rankin E, Vaulont S, Haase VH, et al. Regulation of iron homeostasis by the hypoxia-inducible transcription factors (HIFs). J Clin Invest. 2007;117(7):1926–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Blazsek I, Farabos C, Quittet P, Labat ML, Bringuier AF, Triana BK, et al. Bone marrow stromal cell defects and 1 alpha,25-dihydroxyvitamin D3 deficiency underlying human myeloid leukemias. Cancer Detect Prev. 1996;20(1):31–42.

    CAS  PubMed  Google Scholar 

  19. Glorieux G, Vanholder R. Blunted response to vitamin D in uremia. Kidney Int Suppl. 2001;78:S182–5.

    Article  CAS  PubMed  Google Scholar 

  20. Sezer S, Tutal E, Bilgic A, Ozdemir FN, Haberal M. Possible influence of vitamin D receptor gene polymorphisms on recombinant human erythropoietin requirements in dialysis patients. Transplant Proc. 2007;39(1):40–4.

    Article  CAS  PubMed  Google Scholar 

  21. Erturk S, Kutlay S, Karabulut HG, Keven K, Nergizoglu G, Ates K, et al. The impact of vitamin D receptor genotype on the management of anemia in hemodialysis patients. Am J Kidney Dis. 2002;40(4):816–23.

    Article  CAS  PubMed  Google Scholar 

  22. Amato M, Pacini S, Aterini S, Punzi T, Gulisano M, Ruggiero M. Iron indices and vitamin D receptor polymorphisms in hemodialysis patients. Adv Chronic Kidney Dis. 2008;15(2):186–90.

    Article  PubMed  Google Scholar 

  23. Alon DB, Chaimovitz C, Dvilansky A, Lugassy G, Douvdevani A, Shany S, et al. Novel role of 1,25(OH)(2)D(3) in induction of erythroid progenitor cell proliferation. Exp Hematol. 2002;30(5):403–9.

    Article  PubMed  Google Scholar 

  24. Falko JM, Guy JT, Smith RE, Mazzaferri EL. Primary hyperparathyroidism and anemia. Arch Intern Med. 1976;136(8):887–9.

    Article  CAS  PubMed  Google Scholar 

  25. Rao DS, Shih MS, Mohini R. Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med. 1993;328(3):171–5.

    Article  CAS  PubMed  Google Scholar 

  26. Mandolfo S, Malberti F, Farina M, Villa G, Scanziani R, Surian M, et al. Parathyroidectomy and response to erythropoietin therapy in anaemic patients with chronic renal failure. Nephrol Dial Transplant. 1998;13(10):2708–9.

    Article  CAS  PubMed  Google Scholar 

  27. Urena P, Eckardt KU, Sarfati E, Zingraff J, Zins B, Roullet JB, et al. Serum erythropoietin and erythropoiesis in primary and secondary hyperparathyroidism: effect of parathyroidectomy. Nephron. 1991;59(3):384–93.

    Article  CAS  PubMed  Google Scholar 

  28. Washio M, Iseki K, Onoyama K, Oh Y, Nakamoto M, Fujimi S, et al. Elevation of serum erythropoietin after subtotal parathyroidectomy in chronic haemodialysis patients. Nephrol Dial Transplant. 1992;7(2):121–4.

    CAS  PubMed  Google Scholar 

  29. Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006;355(20):2071–84.

    Article  CAS  PubMed  Google Scholar 

  30. Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355(20):2085–98.

    Article  CAS  PubMed  Google Scholar 

  31. Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med. 2009;361(21):2019–32.

    Article  PubMed  Google Scholar 

  32. Kilpatrick RD, Critchlow CW, Fishbane S, Besarab A, Stehman-Breen C, Krishnan M, et al. Greater epoetin alfa responsiveness is associated with improved survival in hemodialysis patients. Clin J Am Soc Nephrol. 2008;3(4):1077–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Macdougall IC, Bock AH, Carrera F, Eckardt KU, Gaillard C, Van WD, et al. FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia. Nephrol Dial Transplant. 2014;29(11):2075–84.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Goicoechea M, Vazquez MI, Ruiz MA, Gomez-Campdera F, Perez-Garcia R, Valderrabano F. Intravenous calcitriol improves anaemia and reduces the need for erythropoietin in haemodialysis patients. Nephron. 1998;78(1):23–7.

    Article  CAS  PubMed  Google Scholar 

  35. Albitar S, Genin R, Fen-Chong M, Serveaux MO, Schohn D, Chuet C. High-dose alfacalcidol improves anaemia in patients on haemodialysis. Nephrol Dial Transplant. 1997;12(3):514–8.

    Article  CAS  PubMed  Google Scholar 

  36. Saab G, Young DO, Gincherman Y, Giles K, Norwood K, Coyne DW. Prevalence of vitamin D deficiency and the safety and effectiveness of monthly ergocalciferol in hemodialysis patients. Nephron Clin Pract. 2007;105(3):c132–8.

    CAS  PubMed  Google Scholar 

  37. Riccio E, Sabbatini M, Bruzzese D, Capuano I, Migliaccio S, Andreucci M, et al. Effect of paricalcitol vs calcitriol on hemoglobin levels in chronic kidney disease patients: a randomized trial. PLoS ONE. 2015;10(3), e0118174.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Marc G. Vervloet MD, PhD, FERA .

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© 2016 Springer International Publishing Switzerland

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van Breda, F., Vervloet, M.G. (2016). Vitamin D and Anemia in Chronic Kidney Disease. In: Ureña Torres, P., Cozzolino, M., Vervloet, M. (eds) Vitamin D in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-32507-1_23

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  • DOI: https://doi.org/10.1007/978-3-319-32507-1_23

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  • Online ISBN: 978-3-319-32507-1

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