Serum 25(OH)D level is negatively associated with fatigue in elderly maintenance hemodialysis patients

Introduction: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequently observed in maintenance hemodialysis (MHD) patients, and is associated with fracture, muscle weakness, malnutrition, etc.; however, relationships of CKD-MBD markers and fatigue are not well established. Methods: This was a cross-sectional study included 244 MHD patients (89 elders) from July to September 2021 in The First Affiliated Hospital of Shandong First Medical University. CKD-MBD markers and other clinical data were collected from medical records. Fatigue in the past week was measure by Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) fatigue measure; fatigue at the end of hemodialysis was measure by numeric rating scale (NRS). Spearman correlation, linear regression and robust linear regression were. Results: In all MHD patients, Lg(25(OH)D(nmol/L) were negatively correlated with SONG-HD score (beta=-1.503, 95%CI: -2.826--0.18, P=0.026) and NRS score (beta=-1.532, P=0.04) in multiple regression models adjusting for sex, age and all CKD-MBD characters; but no correlations were found on univariate regression or in other multiple regression models. Interactions effects between age >= 65years and Lg(25(OH)D(nmol/L)) in terms of fatigue scores were significant base on multiple linear regressions (SONG-HD score beta=-3.613, P for interaction =0.006; NRS score beta=-3.943, P for interaction=0.008). Compared with non-elderly patients, elderly patients were with higher ACCI scores(7(6, 8) VS 4(3, 5), P<0.001), higher SONG-HD scores (3(2,6) VS 2(1,3), P<0.001), higher NRS score (4(2, 7) VS 3(1, 5), P<0.001), lower serum phosphate levels (1.65(1.29, 2.10) VS 1.87(1.55, 2.26) mmol/L, P=0.002), and lower serum iPTH levels (160.6(90.46,306.45) VS 282.2(139, 445.7) pg/ml, P<0.001). There were no differences in serum calcium, alkaline serum or 25(OH)D levels between the two groups. In elderly patients, lg(25(OH)D were negatively correlated with SONG-HD score (beta=-3.323, P=0.010) and NRS score (beta=-3.521, P=0.006) on univariate linear regressions. Following adjustment for sex, age and all CKD-MBD characters, lg(25(OH)D were negatively correlated with SONG-HD scores (multiple linear regression beta=-4.012, P=0.004; multiple robust regression beta=-4.012, P=0.003) or NRS scores (multiple linear regression beta=-4.104, P=0.002; multiple robust regression beta=-4.104, P=0.001). There were no significant correlations between fatigue scores and other CKD-MBD markers (calcium, phosphate, lgiPTH, alkaline phosphatase) in elderly MHD patients, either on univariate linear regressions or multiple regressions. Conclusion: Serum 25(OH)D level is negatively associated with fatigue in elderly maintenance hemodialysis patients.

Automated summary

This study found that serum 25(OH)D level is negatively associated with fatigue in elderly maintenance hemodialysis patients.