Plasma exchange induces vitamin D deficiency

Hiemstra, T F, Casian, A, Boraks, P, Jayne, D R and Schoenmakers, I (2014) Plasma exchange induces vitamin D deficiency. QJM, 107 (2). pp. 123-130. ISSN 1460-2725

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BACKGROUND: Plasma exchange is used in the treatment of diseases mediated by pathogenic circulating proteins, or for transplant desensitization. Its non-targeted nature results in the depletion of physiologically important molecules, and it is often complicated by hypocalcaemia.  AIM: To determine the effects of plasma exchange on vitamin D binding protein (DBP) and associated vitamin D metabolites.  DESIGN: Single-centre prospective cohort study of 11 patients.  METHODS: DBP and vitamin D metabolites were measured before and immediately after five plasma exchanges, and 7 and 28 days after discontinuation of plasma exchange.  RESULTS: Plasma exchange reduced plasma DBP concentration from 196.9 ± 53.2 to 98.5 ± 34 μg/ml (P = 0.0001), 1,25-dihydroxyvitamin D from 103 ± 52 to 42 ± 4 pmol/l (P = 0.003) and 25-hydroxyvitamin D from 49.7 ± 29 to 22 ± 9.4 nmol/l (P = 0.0017), through their removal in effluent. After 7 days, DBP and 1,25-dihydroxyvitamin D were not significantly different from baseline, but 25-hydroxyvitamin D remained significantly lower after 7 days (26.4 ± 9.8 nmol/l, P = 0.02) and 28 days (30.8 ± 15.5 nmol/l, P = 0.048). Corrected calcium decreased from 2.23 ± 0.11 to 1.98 ± 0.08 mmol/l (P = 0.0007) immediately after five treatments. Plasma calcium was significantly associated with 1,25-dihydroxyvitamin D (r(2) = 0.79, P < 0.0001).  CONCLUSION: Plasma exchange induced an acute reversible decrease in plasma 1,25-dihydroxyvitamin D, DBP, calcium and a sustained decrease in plasma 25-hydroxyvitamin D.

Item Type: Article
Uncontrolled Keywords: adult,aged,calcium,female,humans,male,middle aged,plasma exchange,prospective studies,vitamin d,vitamin d deficiency,vitamin d-binding protein
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Musculoskeletal Medicine
Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine
Depositing User: Pure Connector
Date Deposited: 24 Sep 2016 00:51
Last Modified: 22 Oct 2022 01:31
DOI: 10.1093/qjmed/hct208

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