Kidney Week

Abstract: FR-PO837

A Randomized Controlled Trial Comparing Between Fixed Dose and Serum Level-Based Titration Regimen of Vitamin D Supplementation on Sarcopenia Outcomes Among Dialysis Patients

Session Information

• Health Maintenance, Nutrition, Metabolism - II
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Jiampochaman, Saranchana, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Saranchana Jiampochaman,

• Chuengsaman, Piyatida, Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Bangkok, Thailand

Piyatida Chuengsaman,

• Avihingsanon, Yingyos, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Yingyos Avihingsanon,

• Eiam-Ong, Somchai, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Somchai Eiam-Ong,

• Kittiskulnam, Piyawan, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Piyawan Kittiskulnam,

Background

Low vitamin D status is associated with either low muscle mass or impaired muscle function in dialysis patients. However, there is no consensus on how best to correct vitamin D deficiency in patients with end-stage kidney disease (ESKD). We investigated the effect of different vitamin D supplementation regimens on sarcopenia outcomes in ESKD patients.

Methods

This was a randomized controlled trial (ClinicalTrial.gov NCT05434377). ESKD patients treated with maintenance hemodialysis or peritoneal dialysis with low vitamin D status, defined as serum 25-hydroxyvitamin D (25-OH D) level <30 ng/mL were 1:1 randomized to either receive oral ergocalciferol using a fixed dose regimen of 20,000 IU/week or utilizing serum 25-OH D level-based titration of dosage adjustment as a control group. The change of muscle mass measured by bioimpedance spectroscopy (BIS), muscle strength using a hand grip dynamometer, and physical performance measured by gait speed were determined. Baseline data after 6 months of supplementation were compared between groups.

Results

A total of 76 dialysis patients were enrolled (HD=43%). Baseline characteristics including age, diabetes mellitus, muscle parameters, and dialysis vintage were similar. After supplementation, the average serum 25-OH D levels in the fixed dose and titration groups were significantly elevated from 14.9±6.4 to 28.8±11.5 ng/mL, p<0.001 and from 15.0±7.2 to 26.9±13.2 ng/mL, p<0.001, respectively, but did not differ between groups at 6 months (p=0.52). Despite comparable energy and protein intake, the mean BIS-derived total-body muscle mass normalized to height squared was significantly increased at 6 months in the fixed dose group (14.4±3.4 to 15.3±3.0 kg/m², p<0.03) compared with the titration group (13.6±2.7 to 13.7±3.0 kg/m², p=0.58). However, muscle strength and gait speed were not different between two groups (p>0.05). Neither hypercalcemia nor hyperphosphatemia was found throughout the study.

Conclusion

A fixed dose supplementation of ergocalciferol demonstrates better improvement in muscle mass among patients receiving maintenance dialysis. Vitamin D supplementation appears to be a promising treatment of sarcopenia among dialysis population.

Funding

• Government Support – Non-U.S.