Laurie,
Check this research below on kidney function/failure/death and vitamin D levels...
Have you had your 25(OH)D level checked?
L, Carl
Low vitamin D levels mean higher death rates in patients with kidney disease.
The below study is the first of its kind; Dr. Rajnish Mehrota and his eight colleagues studied 3,000 of the 28 million U.S. adults who have chronic kidney disease, finding those with vitamin D levels below 15 ng/ml had a 50% increased risk of death compared to those with levels above 30 ng/ml over the nine years of the study. These researchers from UCLA, Harvard, the Los Angeles Biomedical Research Institute, and other institutions concluded: "The broad public health implications of our findings cannot be overemphasized given the high prevalence of vitamin D deficiency among individuals with chronic kidney disease, and the ease, safety, and low cost of maintaining replete vitamin D levels."
These words are music to my ears; these words are strong words, urgent words, and, better yet, they are not my words. This is the first large study looking at a representative group of Americans with kidney disease, before dialysis, finding about 1/3 of them died over the 9 years of the study. Those with low vitamin D levels were more likely to die; in fact, they were more likely to have about every chronic disease you can think of before they died. The average age of those with kidney disease was only 55. This is a very important study, well written and well-conducted.
However, there is a scandal in medicine, a scandal not openly discussed in scientific papers, one not yet reported by the mainstream press. The scandal is this: if you are on dialysis, the chances are very high that your kidney doctor thinks he is giving you vitamin D when he is doing no such thing and some drug companies encourage such ignorance.
Drug companies market very lucrative activated vitamin D drugs to nephrologists as "vitamin D." The kidney doctors, in turn, think they are giving vitamin D to their dialysis patients when they are doing no such thing. If anything, the activated vitamin D analogs nephrologists use in kidney disease will lower 25(OH)D levels by turning on the enzyme that gets rid of vitamin D.
The ugly secret is that plain old dirt-cheap vitamin D would lower the amount of activated vitamin D analogs needed to treat kidney disease. We used to think it was all or none, the kidneys would either make activated vitamin D to maintain blood calcium or the kidneys would not, as in renal failure. However, it is not all or none; the more vitamin D building blocks available to the diseased kidneys, the more activated vitamin D diseased kidneys can make. And, tissues other than the kidney, such as the skin, pancreas, adrenal medulla, and certain white blood cells, can contribute to serum activated vitamin D levels, and probably would if they had enough of the building block (plain old, dirt-cheap old, regular old, vitamin D).
Just out: Vitamin D administration (plain old vitamin D) to renal dialysis patients reduces the need for expensive vitamin D analogues, reduces inflammation, reduces the need for medication that increases red blood count, and improves cardiac function.
As I was about to finish this tirade about vitamin D and kidney failure, the below open study was published on March 4, 2010 and I ordered it. (By the way, the Council has to pay $11.00 for every paper I get and only one paper in ten is worth reporting on). The study below confirms what the above authors predicted; plain old cheap vitamin D helps patients with kidney disease.
Dr. Patricia Matias and colleagues in Portugal gave vitamin D3 to 158 patients on renal dialysis, using a sliding scale of vitamin D3 administration dependent on baseline 25(OH)D levels. Some patients got 50,000 IU per week, some got 10,000 IU per week, etc. Their dosing regimen increased 25(OH)D levels from a mean of 22 ng/ml at the beginning of the study to a mean of 42 ng/ml during treatment, indicating half of patients still had levels lower than 42 ng/ml after treatment. Interestingly, most of the patients who did not increase their 25(OH)D very much had diabetes, suggesting the metabolic clearance (how quickly it is used up) of vitamin D is increased in diabetes. By the way, we know the patients took the vitamin D; the doctors gave it to them when they came in for dialysis.
The results of this study were amazing. After vitamin D administration, parathyroid hormone, albumin, CRP (a measure of inflammation), brain natriuretic peptide (a measure of heart failure), and left ventricular mass index (a measure of heart function) all improved significantly. The dose of activated vitamin D (Zemplar in this case) was reduced, and some patients were able to stop it all together. Also, the dose of two other drugs used in kidney failure, one to bind phosphorus and the other to raise hemoglobin, was reduced.
It is a tragedy that drug companies sell more expensive vitamin D analogs by having their drug salesman assure kidney doctors that the expensive vitamin D analogues are vitamin D, even if it kills their clients. But, with the brand new knowledge that kidney failure patients live much longer on vitamin D, the drug companies might want to do some simple math. They might make even more money if they kept their patients alive longer. True, they will need less vitamin D analogues and other expensive kidney drugs every day, but the patients may live many more days.
John Cannell, MD
1241 Johnson Ave., #134
San Luis Obispo, CA 93401
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>>Carl<<
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