TY - JOUR
T1 - The effects of short-term vitamin D supplementation on glucose metabolism in dialysis patients
T2 - a systematic review and meta-analysis
AU - Sarathy, Harini
AU - Pramanik, Vedatrayee
AU - Kahn, Jared
AU - Abramowitz, Matthew K.
AU - Meier, Kristen
AU - Kishore, Preeti
AU - Melamed, Michal L.
N1 - Publisher Copyright:
© 2015, Springer Science+Business Media Dordrecht.
PY - 2015/2/26
Y1 - 2015/2/26
N2 - 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.
AB - 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.
KW - Dialysis
KW - Insulin resistance
KW - Intervention studies
KW - Meta-analysis
KW - Vitamin D
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U2 - 10.1007/s11255-015-0909-0
DO - 10.1007/s11255-015-0909-0
M3 - Article
C2 - 25636811
AN - SCOPUS:84925521841
SN - 0301-1623
VL - 47
SP - 537
EP - 549
JO - International Urology and Nephrology
JF - International Urology and Nephrology
IS - 3
ER -