Introduction:
In chronic kidney disease, sarcopenia develops through mechanisms distinct from age-related primary sarcopenia. Hormonal imbalances, such as vitamin D deficiency, play a key role in this process. This study explores the impact of cholecalciferol supplementation on sarcopenia in both vitamin D deficient and sufficient CKD patients, comparing outcomes in those undergoing dialysis and those who are not.
Methods:
This 3 month prospective nonrandomized interventional study included patients of CKD5D and CKD5ND of age 18 to 60 years who were screened from nephrology OPD during September 2023 to august 2024. Bedridden patients, pregnant women, those having malignancies, HIV, active tuberculosis, chronic liver disease, endocrine disorders and and currently on vitamin D supplements were excluded. Data including Demographic profile, comorbidities, dialysis vintage, anthropometric measurement including BMI, mid-upper arm circumference (MUAC), triceps fat fold (TFF) thickness, mid-arm muscle circumference (MAMC) were collected. various hormonal fasting profile was sent(iPTH ,vitamin D3,LH, FSH,cortisol,prolactin,testosterone,IGF-1).AWGS 2019 criteria was used to diagnose Sarcopenia as both Handgrip strength (by dynamometer) was <28 kg for men and <18 kg for women along with appendicular skeletal muscle index <7.0 kg/m² for men and <5.7 kg/m² for women (calculated by Fresenius body composition monitor). ASMI was calculated by the following equation:ASM (kg)= -1.838 +0.395 x total body water(L) + 0.105 x body weight (kg) +1.231 x male sex - 0.026 x age (years). ASM/m2= ASMI.
Sarcopenic ESRD patients with vitamin D (25(OH)D) levels deficient (<30 ng/ml) and sufficient(>30 ng/ml) were given cholecalciferol supplementation 60,000 IU weekly and fortnightly respectively for 12 weeks. At 3 months follow-up vitamin D, serum calcium levels, handgrip, ASMI and other anthropometric measures were checked and if toxicity (vitamin D >80 ng/ml and calcium >10.5 mg/dl they were excluded
Results:
300 CKD5D and CKD5ND patients were screened, out of which 103 were sarcopenic (59 CKD5D and 44 CKD5ND).They were divided in 4 groups as CKD5D – vitamin D deficient (group1) CKD5D sufficient (group2), CKD5ND deficient(group 3) and sufficient (group 4).At baseline in CKD5D and CKD5ND sarcopenic group, 69% and 70% respectively were males with mean age 42.2 years and 41.2 years. In CKD 5 D and CKD 5 ND 83% and 84% respectively were vitamin D deficient. They were supplemented with once weekly vitamin D for 12 weeks while those with sufficient vitamin D (group 2 and 4) were given fortnightly vitamin D supplementation for 12 weeks. After applying pair t test significant improvement in handgrip, ASMI, BMI, MUAC, TTF, MUMC vitamin D and calcium levels were seen in all the groups except in group 3, ASMI improvement was not significant as shown in the table below.
Conclusions:
In sarcopenic end stage renal disease patients after vitamin d supplementation irrespective of initial deficiency or sufficiency there is significant improvement in sarcopenic parameters (ASMI and handgrip). However, in CKD5D non-significant improvement in ASMI was seen. Similarly, vitamin d supplementation also significantly improves BMI, MUAC, TTF, MUMC parameters after three months. Long term effect (more than 6 months) of this supplementation is under trial. Based on this study, other deficient hormones can be planned for supplementation in future for sarcopenia improvement.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.