Evaluating the Therapeutic Potential of the Biologically Active Form of Vitamin D in the Management of Acute Renal Failure: A Randomized Single-Blind Clinical Trial
Authors
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Asiye Ommat Mohamadi
Department of Internal Medicine, Nohom Day Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
https://orcid.org/0000-0001-6365-8537
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Mostafa Enayatrad
Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
https://orcid.org/0000-0003-3465-3715
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Amirhessam Kheirieh
Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
https://orcid.org/0000-0003-4441-0688
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Sepideh Mahdavi
Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
https://orcid.org/0000-0003-2161-5496
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Monireh Amerian
School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran.
https://orcid.org/0000-0002-2175-4720
DOI:
https://doi.org/10.22100/ijhs.v12i4.1277Keywords:
Acute renal failure, Creatinine, Iran, Urea, Vitamin DAbstract
Background: This study was designed to evaluate the impact of the active form of vitamin D on the progression of Acute Renal Failure (ARF) and the improvement of renal function markers.
Methods: This single-center, randomized, parallel-group clinical trial was conducted in adult patients (>18 years) diagnosed with ARF according to KDIGO criteria. Exclusion criteria included a history of chronic kidney disease, kidney transplantation, primary parathyroid or granulomatous disease, symptomatic nephrolithiasis, pregnancy or breastfeeding, or recent vitamin D supplementation. Participants in the intervention group received oral active vitamin D (1,25-dihydroxy-vitamin D) at a dose of 0.25 mg once daily, whereas the control group received routine care for ARF. Treatment continued for up to three months or until recovery. Analyses followed the intention-to-treat principle. Continuous variables were analyzed using repeated measures ANOVA, and categorical variables were compared using chi-square or Student’s t-tests, with statistical significance set at P-value<0.05.
Results: Repeated measures showed a significant decrease in mean urea levels within each group over time (P-value=0.006), but no significant difference was found between groups (P-value=0.342). Similarly, creatinine levels decreased in both groups, but differences between groups were not statistically significant (P-value=0.511).
Conclusion: The study found no strong evidence that oral active vitamin D improves recovery compared with routine treatment alone in patients with ARF. Larger trials with higher doses and longer follow-up are needed to determine whether vitamin D supplementation could be beneficial.
References
Deng F, Peng M, Li J, Chen Y, Zhang B, Zhao S. Nomogram to predict the risk of septic acute kidney injury in the first 24 h of admission: an analysis of intensive care unit data. Renal Failure 2020;42(1):428-436. doi: 10.1080/0886022X.2020.1761832
Raimann JG, Riella MC, Levin NW. International Society of Nephrology's 0by25 initiative (zero preventable deaths from acute kidney injury by 2025): focus on diagnosis of acute kidney injury in low-income countries. Clinical Kidney Journal 2018;11(1):12-19. doi: 10.1093/ckj/sfw134
Susantitaphong P, Cruz D, Cerda J, et al. Acute Kidney Injury Advisory Group of the American Society of Nephrology: World incidence of AKI: a meta-analysis. Clinical Journal of the American Society of Nephrology 2014;9(6):1148-1148.
Chawla L, Eggers P, Star R. Acute kidney injury and chronic kidney disease as interconnected syndromes. The New England Journal of Medicine 2014;371:58-66. doi: 10.1056/NEJMra1214243
Yang L, Xing G, Wang L, et al. Acute kidney injury in China: a cross-sectional survey. Lancet 2015;386(10002):1465-71. doi: 10.1016/S0140-6736(15)00344-X
Leblanc M, Kellum JA, Gibney RT, Lieberthal W, Tumlin J, Mehta R. Risk factors for acute renal failure: inherent and modifiable risks. Current Opinion in Critical Care 2005;11(6):533-6. doi: 10.1097/01.ccx.0000183666.54717.3d
Rahim Ahmed MS, Umer A, Azim A, Jamil MT, Haque A. Frequency of exposure of nephrotoxic drugs and drug-induced acute kidney injury in pediatric intensive care unit: a retrospective review from a tertiary care centre in Pakistan. Cureus 2020; 12(12):e12183. doi: 10.7759/cureus.12183
Alvarez AS, Oyerinde O, Reinert JP. Drug-Induced Kidney Disease Associated With Selected Antibiotics. The Senior Care Pharmacist 2020;35(5):225-229. doi: 10.4140/TCP.n.2020.225
Liu C, Yan S, Wang Y, et al. Drug-Induced Hospital-Acquired Acute Kidney Injury in China: A Multicenter Cross-Sectional Survey. Kidney Diseases (Basel) 2021;7(2):143-155. doi: 10.1159/000510455
Cameron LK, Lei K, Smith S, et al. Vitamin D levels in critically ill patients with acute kidney injury: a protocol for a prospective cohort study (VID-AKI). BMJ Open 2017;7(7):e016486. doi: 10.1136/bmjopen-2017-016486
Di Mario F, Regolisti G, Greco P, et al. Prevention of hypomagnesemia in critically ill patients with acute kidney injury on continuous kidney replacement therapy: the role of early supplementation and close monitoring. Journal of Nephrology 2021;34(4):1271-1279. doi: 10.1007/s40620-020-00864-4
Matsuda M, Kurosaki K, Okamura N. Activated vitamin D3 and pro-activated vitamin D3 attenuate induction of permanent changes caused by neonatal estrogen exposure in the mouse vagina. The Journal of Reproduction and Development 2014;60(4):274-9. doi: 10.1262/jrd.2014-015
Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Archives of Internal Medicine 2008;168(12):1340-9. doi: 10.1001/archinte.168.12.1340
Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Archives of Internal Medicine 2008;168(15):1629-37. doi: 10.1001/archinte.168.15.1629
Kuroda T, Shiraki M, Tanaka S, Ohta H. Contributions of 25-hydroxyvitamin D, co-morbidities and bone mass to mortality in Japanese postmenopausal women. Bone 2009;44(1):168-72. doi: 10.1016/j.bone.2008.03.023
Matias PJ, Ferreira C, Jorge C, et al. 25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients. Nephrology Dialysis Transplantation 2009;24(2):611-8. doi: 10.1093/ndt/gfn502
Chonchol M, Scragg R. 25-Hydroxyvitamin D, insulin resistance, and kidney function in the Third National Health and Nutrition Examination Survey. Kidney International 2007;71(2):134-9. doi: 10.1038/sj.ki.5002002
Graidis S, Papavramidis TS, Papaioannou M. Vitamin D and acute kidney injury: A two-way causality relation and a predictive, prognostic, and therapeutic role of vitamin D. Frontiers in Nutrition 2021;7:630951. doi: 10.3389/fnut.2020.630951
Chow S-C, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research. chapman and hall/CRC; 2017. doi: 10.1201/9781315183084
Mustafar R, Mohd R, Ahmad NM, et al. The effect of calcium with or without calcitriol supplementation on renal function in patients with hypovitaminosis D and chronic kidney disease. Nephro-Urology Monthly 2014;6(1):e13381-e13381. doi: 10.5812/numonthly.13381
Leaf DE, Croy HE, Abrahams SJ, Raed A, Waikar SS. Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients. Critical Care 2015;19(1):80. doi: 10.1186/s13054-015-0812-1
Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294(7):813-8. doi: 10.1001/jama.294.7.813
De Mendonça A, Vincent J-L, Suter P, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Medicine 2000;26(7):915-921. doi: 10.1007/s001340051281
Rasmussen SR, Kandler K, Nielsen RV, Jakobsen PC, Ranucci M, Ravn HB. Association between transfusion of blood products and acute kidney injury following cardiac surgery. Acta Anaesthesiologica Scandinavica 2020;64(10):1397-1404. doi: 10.1111/aas.13664
Zhang R, Naughton DP. Vitamin D in health and disease: Current perspectives. Nutrition Journal 2010;9(1):65. doi: 10.1186/1475-2891-9-65
Amrein K, Schnedl C, Holl A, et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA 2014;312(15):1520-1530. doi: 10.1001/jama.2014.13204
Gonçalves JG, de Bragança AC, Canale D, et al. Vitamin D deficiency aggravates chronic kidney disease progression after ischemic acute kidney injury. PloS One 2014;9(9):e107228. doi: 10.1371/journal.pone.0107228
Zhang H, Jiang Y, Shi N, Lu Y-Q. Serum vitamin D levels and acute kidney injury: A systemic review and meta-analysis. Scientific Reports 2022;12(1):20365. doi: 10.1038/s41598-022-24560-4
Agarwal R, Hynson JE, Hecht TJ, Light RP, Sinha AD. Short-term vitamin D receptor activation increases serum creatinine due to increased production with no effect on the glomerular filtration rate. Kidney International 2011;80(10):1073-1079. doi: 10.1038/ki.2011.207
Xu S, Chen YH, Tan ZX, et al. Vitamin D3 pretreatment regulates renal inflammatory responses during lipopolysaccharide-induced acute kidney injury. Scientific Reports 2015;5:18687. doi: 10.1038/srep18687
Lee J-W, Kim SC, Ko YS, et al. Renoprotective effect of paricalcitol via a modulation of the TLR4-NF-κB pathway in ischemia/reperfusion-induced acute kidney injury. Biochemical and Biophysical Research Communications 2014;444(2):121-127. doi: 10.1016/j.bbrc.2014.01.005
Westhoff JH, Schildhorn C, Jacobi C, et al. Telomere shortening reduces regenerative capacity after acute kidney injury. Journal of the American Society of Nephrology 2010;21(2):327-36. doi: 10.1681/ASN.2009010072
Golmohammadi M-G, Ajam R, Shahbazi A, Chinifroush-Asl MM, Banaei S. Protective effect of vitamin D3 and erythropoietin on renal ischemia/reperfusion-induced liver and kidney damage in rats. Journal of Herbmed Pharmacology 2020;9(3):293-299. doi: 10.34172/jhp.2020.37
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