Vitamin D deficiency is implicated in reduced serum albumin concentrationsin patients with end-stage renal disease

The mortality rate in hemodialysis patients remains extremely high, and red uced serum albumin concentration resulting from malnutrition is the stronge st predictor of mortality and morbidity. Several inflammatory cytokines inv olved in malnutrition, including interleukin-1, interleukin-6, and tumor ne crosis factor-alpha, are modulated by 1,25-dihydroxyvitamin D-3 [1,25-(OH)( 2)D-3], of which synthesis is impaired in end-stage renal disease. We evalu ated whether 1,25-(OH)(2)D-3 deficiency might be involved in reduced serum albumin concentrations. Fifty-one predialysis uremic patients about to begi n hemodialysis therapy were divided into groups with serum 1,25-(OH)(2)D-3 concentrations less than 18 pg/mL (low-D-3 group; n = 39) and concentration s of 18 pg/mL or greater (normal-D-3 group; n = 12). Serum albumin concentr ations before the initiation of hemodialysis treatment were compared betwee n the two groups. Furthermore, the effect of supplementation with active fo rms of vitamin D during 4 months of hemodialysis treatment on serum albumin concentrations was retrospectively evaluated in the low-D-3 group. Serum a lbumin concentrations in the low-D-3 group were significantly less than tho se in the normal-D-3 group (3.58 +/- 0.50 versus 3.82 +/- 0.10 g/dL; P = 0. 034). Considering all patients, a significant positive correlation between serum concentrations of albumin and 1,25-(OH)(2)D-3 was noted (r = 0.417; P = 0.0023). Supplementation with active forms of vitamin D significantly in creased serum albumin concentrations in the low-D-3 group from 3.61 +/- 0.1 2 to 3.79 +/- 0.13 g/dL (P = 0.0067). These findings indicate that reductio ns in serum albumin concentrations may be attributed, at least in part, to vitamin D deficiency in patients with end-stage renal disease. (C) 2000 by the National Kidney Foundation, Inc.