Primary Article Rachel Knepp (Article 1)

• Pecovnik-Balon, B., Jakopin, E., Bevc, S., Knehtl, M., & Gorenjak, M. (2009). Vitamin D as a novel nontraditional risk factor for mortality in hemodialysis patients. Therapeutic Apheresis And Dialysis: Official Peer-Reviewed Journal Of The International Society For Apheresis, The Japanese Society For Apheresis, The Japanese Society For Dialysis Therapy, 13(4), 268-272. Retrieved from MEDLINE with Full Text database.

• Design – Cross Sectional– Observational

• Number of subjects – Initial: 102 (57 men, 45 women) – Final Attrition: 102 (27 died, 75 alive)

Primary Article Cont.Rachel Knepp (Article 1)

• Recruitment– Hemodialysis (HD) patients treated at The Department of Hemodialysis at the

University Clinical center Maribor; located in Slovenia.

• Inclusion Criteria– Must be on hemodialysis being treated the University Clinical center Maribor

• Exclusion Criteria– Not listed in study

Primary Article: ResultsRachel Knepp (Article 1)

• Data Analysis: – SPSS version 12.0, Paired and Independent t-tests, – Kaplan Meier Survival Curves, Cox Regression Model– P-value <.05 was significant

Vitamin D Level Number of patients

Sufficient 25.5% (N= 26)

Mild 37.3% (N=38)

Insufficient 35.5% (N=36)

Severe 2% (N=2)

Primary Article: Results Rachel Knepp (Article 1)

52% of patients had 25D levels > 50 nmol/L, 48% of patients 25D levels from 10.5 to 50 nmol/L.

B Pecˇovnik-Balon et al.

Primary Article: FindingsRachel Knepp (Article 1)

• Limitations of this Study include: – Convenient Sample– No exclusion criteria– Diagnostic Study– Statistical Analysis– All-cause mortality

Primary Article: ConclusionsRachel Knepp (Article 1)

• Vitamin D deficiency in HD patients is a serious condition that is often underdiagnosed, and goes un-recognized by practitioners.

• According this study, most HD patients have vitamin D insufficiency.

• Treatment for vitamin D deficiency will provide benefit to HD patients.

Primary Article: My Conclusion Rachel Knepp (Article 1)

• Lack of detail • Recognizing Vitamin D deficiency in HD

patients is important. • Registered Dietitians role• More research is needed to determine the

degree and prevalence of vitamin D deficiency in hemodialysis patients.

Primary ArticleRachel Knepp (Article 2)

• Taskapan H, Ersoy F, Passadakis P, et al. Severe vitamin D deficiency in chronic renal failure patients on peritoneal dialysis. Clinical Nephrology [serial online]. October 2006;66(4):247-255. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed November 23, 2010.

• Design– Cross-Sectional

• Funding – Akdeniz University Research Fund

• Number of Subjects– Initial: 273 (123 female, 150 male)– Final: 273

Primary Article Cont. Rachel Knepp (Article 2)

• Recruitment– Convenient Sample from 20 Centers around Greece and Turkey.

• Inclusion– 20 years of older, both genders, on PD > 1 year

• Exclusion– Hemodialysis for longer than 2 months during the previous year– Peritonitis with 1 month of the beginning of the study– Hx of parathyroidectomy, – Hx of aluminum containing medications– Corticosteroids > 3 months.

Primary Article: Results Rachel Knepp (article 2)

• Statistical Analysis– Statistical tests, Correlation and linear regression, Pearsons Chi-sqaure tests

and Spearman rank tests, 2- tailored Fisher’s exact tests and Mann-Whitney rank-sum tests

• 53 patients had diabetes mellitus, 215 had non-diabetes mellitus• Patients with DM had lower levels of vitamin d than patients with

non-diabetes mellitus. (p-value < .05)• No significant difference in vitamin D between males and females• Significant differences of vitamin D levels between participants on

active vitamin D and not on active vitamin D.

Primary Article: ResultsRachel Knepp (Article 2)

Primary Articles: ResultsRachel Knepp (article 2)

Primary Article: FindingsRachel Knepp (Article 2)

• Limitations– Bias– Duration– Developing Countries and Ethics– Confounding Factors

Primary Article: ConclusionRachel Knepp (article 2)

• High prevalence of (92%) of PD patients have vitamin deficiency; half had severe vitamin D deficiency

• Vitamin D deficiency is higher in diabetes mellitus patients than non-diabetes patients

• Question: Should we begin vitamin D deficiency on iPTH levels as recommended by K-DOQI or according to vitamin D levels?

• Explore and research more on vitamin D levels of dialysis patients

Primary Article: My ConclusionRachel Knepp (Article 2)

• Questionable validity of article due to bias• Vitamin D deficiency is important to recognize

in PD patients• Further studies need to be completed to

establish optimal treatment levels• Important role for Registered Dieticians