Prevalence of vitamin D deficiency in a predominantly African-American hemodialysis patient population

Background: Vitamin D insufficiency and deficiency are common abnormalities and high risk groups include kidney disease patients and African-Americans. Recommendations on the evaluation of vitamin D levels in CKD and ESKD are ambiguous due to a lack of studies examining epidemiology and treatment. The COVID-19 pandemic has disproportionately affected minorities and has highlighted the need for evidence as studies have examined vitamin D deficiency as a risk factor for COVID-19 complications. We present a case series examining the prevalence of vitamin D deficiency in a predominantly African-American hemodialysis patient population. Methods: Retrospective chart review of all in-center hemodialysis patients at Emory Dialysis in Atlanta, GA. Data extracted from Sep to Nov 2020. We excluded any patients on home therapies. Serum 25(OH)vitamin D concentration total was analyzed. We defined vitamin D insufficiency as 20-29.9 ng/mL and vitamin D deficiency as a level<20 ng/ml. Results: Patients receiving in-center hemodialysis(n=615). Average length of time on dialysis was 5 years and average age was 59.4 years. Patients were 52.5% male(n=323). 91.5%(n=563) of patients were African-American. Mean calcium level for all patients was 8.73 mg/dL and PTH level of 554 pg/mL. Mean vitamin D in all patients was 26.32 ng/mL. 98%(n=603) of patients had a vitamin D level available. All patients with vitamin D level<30 ng/mL=412(68.3%) and all patients with vitamin D level<20 ng/ mL=244(40.5%). African-American patients with a vitamin D level was 552. African-American patients with vitamin D level<30 ng/mL=382 (69.2%) and African-American patients with vitamin D level<20 ng/ml=229(41.5%). Mean vitamin D in African-American patients 25.7 ng/mL and non-African-American patients 32.7 ng/mL, p=0.01. Conclusions: In comparison to others such as the DIVINE trial, we present a larger and more diverse cohort. In our study, African-Americans had a statistically significant lower vitamin D level. A case for replacing 25(OH) vitamin D even in ESKD patients is based on the action of vitamin D beyond mineral metabolism, especially with regard to autocrine regulation of immune function. Future directions include examining effects of treatment on PTH and study of vitamin D deficient patients' risks for adverse events like COVID-19 infection.