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The effects of short-term vitamin D supplementation on glucose metabolism in dialysis patients: a systematic review and meta-analysis

  • Nephrology - Original Paper
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Abstract

Purpose

We tested whether short-term vitamin D supplementation improves insulin resistance in patients with kidney disease, a condition with little intrinsic vitamin D activity.

Methods

PubMed, EMBASE and CENTRAL were searched for relevant observational studies and randomized clinical trials (RCTs). Random-effects models were employed for meta-analysis, and effect sizes were summarized as standardized mean difference (SMD) with 95 % confidence intervals. Separate analyses were done for RCTs and non-randomized intervention studies (NRIS).

Results

Seventeen studies (5 RCTs and 12 NRIS) were included. The meta-analysis population (n = 131) was mostly middle aged (40–50 years), male and non-diabetic, and on hemodialysis. The duration (4–12 weeks) and type of supplementation varied between studies. Among RCTs, compared to placebo, vitamin D supplementation was associated with significant decrease in fasting glucose [SMD −1.13, (−2.11 to −0.11)] and PTH levels [SMD −1.50, (−2.95 to −0.04)] but no difference in fasting insulin levels [SMD 1.32, (−0.15 to 2.79)]. Among NRIS, there was only a significant decrease in PTH levels [SMD −1.68, (−2.55 to −0.82)] between pre- and post-vitamin D treatment levels.

Conclusions

Short-term (4–12 weeks) supplementation with vitamin D is associated with lower fasting glucose levels in ESRD with no change in fasting insulin levels. However, the findings from this study are limited by the studies that were used in the meta-analysis, which were mostly small, used multiple different vitamin D compounds and dosing regimens, and had large heterogeneity, and funnel plots showed that there was a dearth of studies with null or negative finding. Therefore, larger RCTs need to be performed to answer this important clinical question.

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Acknowledgments

Dr. Melamed and Dr. Abramowitz are supported by Grant DK 087783 from the National Institute of Diabetes, Digestive and Kidney Diseases and by Gottschalk Awards from the American Society of Nephrology (ASN Foundation for Kidney Research). Dr. Melamed was also supported by Grant DK 078774.

Conflict of interest

The results presented in this paper have not been published previously. None of the authors have any conflicts of interests to declare.

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Authors and Affiliations

  1. Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA

    Harini Sarathy

  2. Division of Nephrology, Department of Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue – Ullmann 615, Bronx, NY, 10461, USA

    Vedatrayee Pramanik, Matthew K. Abramowitz, Kristen Meier, Preeti Kishore & Michal L. Melamed

  3. Emory University, Atlanta, GA, USA

    Jared Kahn

  4. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Matthew K. Abramowitz & Michal L. Melamed

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  1. Harini Sarathy
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Correspondence to Michal L. Melamed.

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Sarathy, H., Pramanik, V., Kahn, J. et al. The effects of short-term vitamin D supplementation on glucose metabolism in dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol 47, 537–549 (2015). https://doi.org/10.1007/s11255-015-0909-0

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  • DOI: https://doi.org/10.1007/s11255-015-0909-0

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