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Significance of 1,25-Dihydroxyvitamin D3 on Overall Mortality in Peritoneal Dialysis Patients with COVID-19

Baralić et al., Nutrients, doi:10.3390/nu15092050

Apr 2023

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Vitamin D for COVID-19

8th treatment shown to reduce risk in October 2020

^*, now known with p < 0.00000000001 from 120 studies, recognized in 8 countries.

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No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

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Prospective analysis of 52 peritoneal dialysis patients, 31 on calcitriol (vitamin D) therapy. All patients tested positive for COVID-19 during followup (median 26 months). Mortality was significantly lower for patients on calcitriol therapy in univariate Cox regression analysis and in Kaplan-Meier analysis. Multivariate Cox regression analysis showed only diabetes mellitus with statistical significance.

This is the 111th of 120 COVID-19 controlled studies for vitamin D, which collectively show efficacy with p<0.0000000001 (1 in 248 sextillion).

29 studies are RCTs, which show efficacy with p=0.0000024.

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risk of death, 66.8% lower, HR 0.33, p = 0.02, treatment 7 of 31 (22.6%), control 11 of 21 (52.4%), NNT 3.4, Cox proportional hazards.

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Baralić et al., 24 Apr 2023, prospective, France, peer-reviewed, 15 authors, study period March 2020 - September 2022, dosage not specified. Contact: baralicmarko@yahoo.com (corresponding author).

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AI generated summary. Current AI models can provide useful summaries for non-experts, but may be inaccurate and have limited ability to analyze larger context such as the entire evidence base for vitamin D.

Calcitriol therapy significantly reduced mortality in peritoneal dialysis patients with COVID-19.

The article is about the effects of vitamin D (Vit D) on mortality in peritoneal dialysis (PD) patients with COVID-19. PD is a type of renal replacement therapy that is used by nearly 300,000 people worldwide. ESRD patients are at increased risk for severe SARS-CoV-2 infection, but PD carries a lower epidemiologic risk because treatment is administered at home.

During the COVID-19 pandemic, a growing body of work pointed to the protective role of Vit D against severe forms of disease, inflammation, and prevention of death in the general population. Adequate Vit D status has been shown to be a potential preventive factor in preventing the progression of COVID-19 pneumonia and inflammation due to its immunomodulatory role.

The authors of this study evaluated the significance of 1,25-dihydroxyvitamin D3 (calcitriol) therapy, primary disease, biochemical and hematologic analyzes, and previously performed glycan analysis by lectin-based microarray as predictors of mortality in this patient group.

After univariate Cox regression analysis, diabetes mellitus (DM) and calcitriol therapy were found to be potential predictors of mortality. Additional multivariate Cox regression analysis showed only DM was a predictor of mortality. Nevertheless, the use of calcitriol in therapy significantly reduced mortality in this patient group, as shown by the Kaplan-Meier survival curve.

The presence of DM as a concomitant disease proved to be a strong predictor of fatal outcome in PD patients infected with SARS-CoV-2. This is the first study to indicate the importance and beneficial effect of calcitriol therapy on survival in PD patients with COVID-19 infection. In addition, this study points to the possibility that adverse thrombogenic events observed in PD patients during the pandemic may be caused by aberrant fibrinogen glycosylation.

Fibrinogen is an acute-phase reactant and a key player in the regulation of inflammation as well as the first factor in the coagulation cascade. Aberrant fibrinogen glycosylation has been shown to be associated with an increased risk of thrombosis in patients with COVID-19.

The authors conclude that calcitriol therapy may be a beneficial treatment for PD patients with COVID-19, and that further studies are needed to investigate the role of aberrant fibrinogen glycosylation in the pathogenesis of COVID-19-related thrombosis.

Significance of 1,25-Dihydroxyvitamin D3 on Overall Mortality in Peritoneal Dialysis Patients with COVID-19

Marko Baralić, Dragana Robajac, Ana Penezić, Voin Brković, Nikola Gligorijević, Ana Bontić, Jelena Pavlović, Jelena Nikolić, Goran Miljuš, Zorana Dobrijević, Miloš Šunderić, Lucia Pažitná, Jaroslav Katrlík, Olgica Nedić, Mirjana Laušević

Nutrients, doi:10.3390/nu15092050

In previous publications, we pointed out the importance of mannosylation of fibrinogen for the development of cardiovascular complications and fucosylation as a predictor of peritoneal membrane dysfunction in patients on peritoneal dialysis (PD). After a follow-up period of 30 months from the onset of the COVID-19 pandemic, we evaluated the significance of 1,25-dihydroxyvitamin D 3 (calcitriol) therapy, primary disease, biochemical and hematologic analyzes, and previously performed glycan analysis by lectin-based microarray as predictors of mortality in this patient group. After univariate Cox regression analysis, diabetes mellitus (DM) and calcitriol therapy were found to be potential predictors of mortality. Additional multivariate Cox regression analysis confirmed that only DM was a predictor of mortality. Nevertheless, the use of calcitriol in therapy significantly reduced mortality in this patient group, as shown by the Kaplan-Meier survival curve. The presence of DM as a concomitant disease proved to be a strong predictor of fatal outcome in PD patients infected with SARS-CoV-2. This is the first study to indicate the importance and beneficial effect of calcitriol therapy on survival in PD patients with COVID-19 infection. In addition, this study points to the possibility that adverse thrombogenic events observed in PD patients during the pandemic may be caused by aberrant fibrinogen glycosylation.

Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

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