Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Hypovitaminosis D and insulin resistance in peritoneal dialysis patients



An association between hypovitaminosis D and insulin resistance has been highlighted. Effects of vitamin D are not only mediated via the vitamin D receptors by active vitamin D metabolites, but 25(OH)D3 also acts through VDR-independent pathways directly. It was reported that acute and chronic intravenous 1,25-dihydroxycholecalciferol therapy corrects insulin resistance in dialysis patients. There are no studies in patients on dialysis which evaluated relationship between 25(OH)D levels and insulin resistance. The aim of this study was to evaluate relationship between serum 25 (OH) D levels and insulin resistance in nondiabetic patients on peritoneal dialysis (PD).

Material methods

We studied 53 nondiabetic patients on PD and in 25 age-, gender- and body mass index-matched healthy controls. Insulin resistance was evaluated by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. Vitamin D deficiency was defined if 25(OH)D3 levels are equal to or less to 15 ng/ml.


Mean HOMA-IR index in patients on PD (3.1 ± 3.3) was significantly higher than those of controls (1.7 ± 1.9) (P < 0.05). The mean 25 (OH)D level in PD patients was (21.1 ± 19.0 ng/ml) lower than those of controls (27.5 ± 9.3 ng/ml) (P < 0.05). Twenty-five (47.2%) PD patients had vitamin D deficiency [mean 25(OH)D: 7.2 ± 3.2 ng/ml], and in 28 of them (52.8%) 25 (OH)D levels were more than 15 ng/ml (mean 33.5 ± 18.7 ng/ml). In PD patients with vitamin D deficiency, mean HOMA-IR index (4.2 ± 3.8) was significantly higher than that of PD patients whose 25 (OH)D levels were more than 15 ng/ml (2.2 ± 2.4) (P < 0.05). Twenty-one (84.0%) of PD patients with vitamin D deficiency, and 22 (78.6%) PD patients whose 25 (OH)D levels were more than 15 ng/mL have been receiving active vitamin D compounds for parathyroid hormone (PTH) control (P > 0.05). There was no significant difference between two PD groups according to mean duration of PD, age, gender, PTH, serum calcium, phosphorus, percentage of fat, and body mass index. There was a negative correlation between HOMA-IR index and 25 (OH)D levels in PD patients (r: −0,368, P < 0,05). In multiple regression analyses, the independent predictors of HOMA-IR index were 25(OH)D3 levels, duration of dialysis, and percentage of fat (measured by bioelectrical impedance) in PD patients.


Our findings show a negative correlation of 25(OH)D levels with insulin resistance in PD patients. PD patients with hypovitaminosis D are at higher risk of insulin resistance even if they are on treatment with active vitamin D for PTH control. Further studies are required to explore the relation between vitamin D deficiency and insulin resistance in PD patients.

This is a preview of subscription content, log in to check access.


  1. 1.

    Tangpricha V, Pearce EN, Chen TC et al (2002) Vitamin D insufficiency among free-living healthy young adults. Am J Med 112(8):659–662

  2. 2.

    Van der Wielen RP, Lowik MR, Van den Berg H et al (1995) Serum vitamin D concentrations among elderly people in Europe. Lancet 346:207–210

  3. 3.

    Chiu KC, Chu A, Go VL, Saad MF (2004) Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 79(5):820

  4. 4.

    Mertens PR, Müller R (2009) Vitamin D and cardiovascular risk. Int Urol Nephrol (Epub ahead of print)

  5. 5.

    Neves PL, Malho A, Cabrita A, Pinho A, Baptista A, Morgado E, Faísca M, Carrasqueira H, Silva AP (2009) Statins and vitamin D: a friendly association in pre-dialysis patients. Int Urol Nephrol (Epub ahead of print)

  6. 6.

    Rammos G, Tseke P, Ziakka S (2008) Vitamin D, the renin-angiotensin system, and insulin resistance. Int Urol Nephrol 40(2):419–426 (review)

  7. 7.

    Taskapan H, Wei M, Oreopoulos DG (2006) 25(OH) Vitamin D(3) in patients with chronic kidney disease and those on dialysis: rediscovering its importance. Int Urol Nephrol 38(2):323–329

  8. 8.

    Taskapan H, Ersoy FF, Passadakis P, Tam P, Memmos D, Katopodis K, Ozener C, Akcicek F, Camsarı T, Ates K, Ataman R, Vlachojannis JG, Dombros N, Utas C, Akpolat T, Bozfakioglu S, Wu GG, Karayaylalı I, Arınsoy T, Stathakis Ch, Yavuz M, Tsakiris D, Dimitriades A, Yılmaz ME, Gültekin M, Karayalçın B, Polat N, Oreopoulos DG (2006) Severe vitamin D deficiency in chronic renal failure patients on peritoneal dialysis. Clin Nephrol Clin Nephrol 66(4):247–255

  9. 9.

    Taskapan H, Ersoy FF, Passadakis P, Tam P, Memmos D, Katopodis K, Ozener C, Akcicek F, Camsarı T, Ates K, Ataman R, Vlachojannis JG, Dombros N, Utas C, Akpolat T, Bozfakioglu S, Wu GG, Karayaylalı I, Arınsoy T, Stathakis Ch, Yavuz M, Tsakiris D, Dimitriades A, Yılmaz ME, Gültekin M, Karayalçın B, Polat N, Oreopoulos DG (2005) Body pain during daily activities in patients on peritoneal dialysis. Dial Transplant 2:58–72

  10. 10.

    Scragg R, Sowers M, Bell C (2004) Serum 25-Hydroxyvitamin D, Diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care 27:2813–2818

  11. 11.

    DeFronzo RA, Alvestrand A, Smith D, Hendler R, Hendler E, Wahren J (1981) Insulin resistance in uremia. J Clin Invest 67:563–568

  12. 12.

    Pittas AG, Harris SS, Stark PC, Dawson-Hughes B (2007) The effects of calcium and vitamin D supplementation on blood glucose and markers of ınflammation in nondiabetic adults. Diabetes Care 30:980–986

  13. 13.

    Mak RHK (1992) Amelioration of hypertension and insulin resistance by 1, 25-dihydroxycholecalciferol in hemodialysis patients. Pediatr Nephrol 6:345–348

  14. 14.

    Mak RHK (1992) Intravenous 1, 25 dihydroxycholecalciferol corrects glucose intolerance in hemodialysis patients. Kidney Int 41:1049–1054

  15. 15.

    Türk S, Yeksan M, Tamer N, Gürbilek M, Erdogan Y, Erkul Ï (1992) Effect of 1, 25 (OH)2 D3 treatment on glucose intolerance in uraemia. Nephrol Dial Transplant 7:1207–1212

  16. 16.

    Gunal AI, Celìker H, Celebì H, Ustundag B, Gunal SY (1997) Intravenous alfacalcidol improves insulin resistance in hemodialysis patients. Clin Nephrol 48:109–113

  17. 17.

    Lin S, Lin Y, Lu K, Diang L, Chyr S, Liao W, Shieh S (1994) Effects of intravenous calcitriol on lipid profiles and glucose tolerance in uraemic patients with secondary hyperparathyroidism. Clin Sci 87:533–538

  18. 18.

    Mak RHK (1998) 1, 25-dihydroxyvitamin D3 corrects insulin and lipid abnormalities in uremia. Kidney Int 53:1353–1357

  19. 19.

    Strózecki P, Kretowicz M, Odrow-Sypniewska G, Manitius J (2004) The ınfluence of ıntravenous 1, 25(OH)2D3 therapy on glucose metabolism in hemodialyzed patients with secondary hyperparathyroidism. Ren Fail 26:345–348

  20. 20.

    Blair D, Byham-Gray L, Lewis E, McCaffrey S (2008) Prevalence of vitamin D [25(OH)D] deficiency and effects of supplementation with ergocalciferol (vitamin D2) in stage 5 chronic kidney disease patients. J Ren Nutr 18:375–382

  21. 21.

    Kautzky-Willer A, Pacini G, Barnas U, Ludvik B, Streli C, Graf H, Prager R (1995) Intravenous calcitriol normalizes insulin sensitivity in uremic patients. Kidney Int 47:200–206

  22. 22.

    Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, Steele D, Chang Y, Camargo CA Jr, Tonelli M, Thadhani R (2007) Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 72:1004–1013

  23. 23.

    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419

  24. 24.

    Inzucchi SE, Maggs DG, Spollett GR, Page SL, Rife FS, Walton V, Shulman GI (1998) Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus. 338(13):867–872

  25. 25.

    Bonakdaran S, Ayatollahi H, Mojahedi MJ, Sharifipoor F, Shakeri M (2008) Impact of treatment with oral calcitriol on glucose intolerance and dyslipidemia(s) in hemodialysis patients. Saudi J Kidney Dis Transpl 19(6):942–947

  26. 26.

    Holick MF (2003) Vitamin D: a millenium perspective. J Cell Biochem 88:296–307

  27. 27.

    Smith EL, Walworth ND, Holick MF (1986) Effect of 1, 25-dihydroxyvitamin D3 on the morphologic and biochemical differentiation of cultured human epidermal keratinocytes grown in serum-free conditions. J Invest Dermatol 86:709–714

  28. 28.

    Dusso AS, Finch J, Brown A et al (1991) Extrarenal production of calcitriol in normal and uremic humans. J Clin Endocrinol Metab 72:157–164

  29. 29.

    Stumpf WE, Sar M, Reid FA et al (1979) Target cells for 1, 25-dihydroxyvitamin D3 in intestinal tract, stomach, kidney, skin, pituitary, and parathyroid. Science 206:1188–1190

  30. 30.

    Dusso A, Lopez-Hilker S, Rapp N, Slatopolsky E (1988) Extra-renal production of calcitriol in chronic renal failure. Kidney Int 34:368–375

  31. 31.

    Lambert PW, Stern PH, Avioli RC et al (1982) Evidence for extrarenal production of 1 alpha, 25-dihydroxyvitamin D in man. J Clin Invest 69:722–725

  32. 32.

    Pettifor JM, Bikle DD, Cavaleros M et al (1995) Serum levels of free 1, 25-dihydroxyvitamin D in vitamin toxicity. Ann Intern Med 122(7):5111–5133

  33. 33.

    Guilherme A, Virbasius JV, Puri V et al (2008) Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nat Rev Mol Cell Biol 9:367–377

  34. 34.

    Ozcan U, Cao Q, Yilmaz E et al (2004) Endoplasmic reticulum stress links obesity, insulin action, and type 2 diabetes. Science 306:457–461

  35. 35.

    Trirogoff ML, Shintani A, Himmelfarb J et al (2007) Body mass index and fat mass are the primary correlates of insulin resistance in nondiabetic stage 3–4 chronic kidney disease patients. Am J Clin Nutr 86:1642–1648

  36. 36.

    Sanches FM, Avesani CM, Kamimura MA et al (2008) Waist circumference and visceral fat in CKD: a cross-sectional study. Am J Kidney Dis 52(1):66–73

  37. 37.

    Axelsson J, Rashid Qureshi A, Suliman ME et al (2004) Truncal fat mass as a contributor to inflammation in end-stage renal disease. Am J Clin Nutr 80:1222–1229

Download references


This study was supported by Inonu University Medical Research Center.

Author information

Correspondence to Hulya Taskapan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bindal, M.E., Taskapan, H. Hypovitaminosis D and insulin resistance in peritoneal dialysis patients. Int Urol Nephrol 43, 527–534 (2011). https://doi.org/10.1007/s11255-010-9813-9

Download citation


  • Dialysis
  • Insulin Resistance
  • Vitamin D
  • 25 (OH) D