THE PREVALENCE OF VITAMIN B12 DEFICIENCY IN HEMODIALYSIS PATIENTS

Authors

  • Alaa H. A. Alkrush College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Sarhad Ahmed Mahmood Dialysis Department, Ministry of Health, Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10437

Keywords:

Vitamin B 12 deficiency, Hemodialysis

Abstract

Background
Vitamin B12 is a water-soluble vitamin in several normal cellular functions. Low vitamin B12 has been associated with high concentrations of homocysteine and can lead to health complications. In addition to metabolic alteration and restricted food products allowable in renal failure patients, vitamin B12 is actively removed by hemodialysis with high flux membranes.


Objective
To detect the prevalence of vitamin B12 levels in hemodialysis patients and its relation to the duration of dialysis and daily protein intake.


Method
This cross-section observational multicenter study was conducted on 169 hemodialysis patients in four Sulaimani Governorate centres. A questionnaire used to gather data included patient, dialysis, diet, and medication information. Blood investigation was taken to detect the vitamin B12 level and mean corpuscular volume.


Results
Twenty-nine patients (17.1 %) had vitamin B12 deficiency. High flux filter hemodialysis was not used in all the centres included in this study. No cases with four hours of dialysis sessions had vitamin B12 deficiency. All the patients were on sub-optimum protein diet restriction. No cases of vitamin B12 deficiency were present in patients receiving protein of 0.6-0.7 gm/kg/day. All our patients had normochromic normocytic anaemia.


Conclusion
Our patients have an average percentage of vitamin B12 deficiency compared to other centres worldwide. The main causes of vitamin B12 deficiency in our patients were the sub-optimum restriction of protein diet and the sub-optimum dialysis.

References

Kang S, Wong P, Malinow M. Hyperhomocyst(e) inemia as a risk factor for occlusive vascular disease. Annu. Rev. Nutr. 1992;12: 279–298.

Dietary Reference Intakes: Thiamin R, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Institute of Medicine. Food and Nutrition Board.

Allen LH. Vitamin B-12. Adv Nutr 2012; 3:54-5.

Stabler SP, Marriott BP, Birt DF, Stallings VA. Present Knowledge in Nutrition. 11th ed. Washington, DC: Elsevier. 2020;257–71.

Barnabé A, Aléssio AC, Bittar LF, de Moraes Mazetto B. Folate, vitamin B12 and Homocysteine status in the post-folic acid fortification era in different subgroups of the Brazilian population attended to at a public health care centre. Nutr J. 2015 Feb 19; 14:19.

Ross AC, Caballero B, Cousins RJ, Tucker KL. Modern nutrition in health and disease. Jones & Bartlett Learning; 2020 July 10.

Debreceni B, Debreceni L. The role of homocysteinelowering B-vitamins in the primary prevention of cardiovascular disease. Cardiovasc Ther. 2014; 32:130-8.

Djuric D, Jakovljevic V, Zivkovic V, Srejovic I. Homocysteine and homocysteine-related compounds: An overview of the roles in the pathology of the cardiovascular and nervous systems. Can J Physiol Pharmacol. 2018; 96:991-1003.

Socha DS, DeSouza SI, Flagg A, Sekeres M, Rogers HJ. Severe megaloblastic anaemia: Vitamin deficiency and other causes. Cleveland clinic journal of medicine. 2020 Mar 1;87(3):153-64.

Stabler SP. Vitamin B12. In: Marriott BP, Birt DF, Stallings VA, Yates AA, eds. Present Knowledge in Nutrition. 11th ed. Washington, DC: Elsevier; 2020:257-71

Gupta E, Mishra P. Functional food with some health benefits, so-called superfood: a review. Current Nutrition & Food Science. 2021 Feb 1;17(2):144-66.

Lonnie M, Hooker E, Brunstrom JM, Corfe BM, Green MA, Watson AW, Williams EA, Stevenson EJ, Penson S, Johnstone AM. Protein for life: Review of optimal protein intake, sustainable dietary sources and the effect on appetite in ageing adults. Nutrients. 2018 Mar 16;10(3):360.

Barabási AL, Menichetti G, Loscalzo J. The unmapped chemical complexity of our diet. Nature Food. 2020 Jan;1(1):33-7.

Boeschoten EW, Schrijver J, Krediet RT, Schreurs WH, Arisz L. Deficiencies of vitamins in CAPD patients: the effect of supplementation. Nephrology Dialysis Transplantation. 1988 Jan 1;3(2):187-93.

Iqbal N, Azar D, Yun YM, Ghausi O, Ix J, Fitzgerald RL. Serum methylmalonic acid and holotranscobalamin-II as markers for vitamin B12

deficiency in end-stage renal disease patients. Annals of Clinical & Laboratory Science. 2013 Jun 20;43(3):243-9.

Chen Y, Smith-Norowitz TA, Joks R. Levels of Salivary Melatonin (AM and PM) in Adults with Allergic Respiratory Disease. Annals of Clinical &

Laboratory Science. 2022 May 1;52(3):507-9.

Dierkes J, Domröse U, Ambrosch A, Schneede J, Guttormsen AB, Neumann KH, Luley C. Supplementation with vitamin B12 decreases

homocysteine and methylmalonic acid but also serum folate in patients with end-stage renal disease. Metabolism. 1999 May 1;48(5):631-5.

Hyndman ME., Manns BJ, Snyder FF, Bridge PJ, Scott-Douglas NW, Fung E, Parsons HG. Vitamin B12 decreases but does not normalize, homocysteine and methylmalonic acid in end-stage renal disease: a link with glycine metabolism and a possible explanation of hyperhomocysteinemia in end-stage renal disease. Metabolism. 2003 Feb 1;52(2):168-72.

Su VC, Shalansky K, Jastrzebski J, Martyn A, Li G, Yeung CK, Snyder F, Zalunardo N. Parenteral vitamin B12 in macrocytic hemodialysis patients reduced MMA levels but did not change mean red cell volume or haemoglobin. Clinical nephrology. 2011 Apr 1;75(4):336-45.

Trimarchi H, Forrester M, Schropp J, Pereyra H, Freixas EA. Low initial vitamin B12 levels in Helicobacter pylori-positive patients on

chronic hemodialysis. Nephron Clinical Practice. 2004;96(1):c28-32

Leypoldt JK, Jaber BL, Lysaght MJ, McCarthy JT, Moran J. Kinetics and dosing predictions for daily haemofiltration. Nephrology Dialysis Transplantation. 2003 Apr 1;18(4):769-76.

Chandna SM, Tattersall JE, Nevett G, Tew CJ, O’Sullivan J, Greenwood RN, Farrington K. Low serum vitamin B12 levels in chronic high-flux hemodialysis patients. Nephron. 1997;75(3):259-63.

Saifan C, Samarneh M, Shtaynberg N, Nasr R, ElCharabaty E, El-Sayegh S. Treatment of confirmed B12 deficiency in hemodialysis patients improves Epogen® requirements. International journal of nephrology and renovascular disease. 2013 Jun 5:89-93.

Van Guldener C, Kulik W, Berger R, Dijkstra DA, Jakobs C, Reijngoud DJ, Donker AJ, Stehouwer CD, De Meer K. Homocysteine and methionine metabolism in ESRD: a stable isotope study. Kidney international. 1999 Sep 1;56(3):1064-71.

Rowland I, Gibson G, Heinken A, Scott K, Swann J, Thiele I, Tuohy K. Gut microbiota functions metabolism of nutrients and other food components. European journal of nutrition. 2018 Feb;57:1-24.

Kosmadakis G, Da Costa Correia E, Carceles O, Somda F, Aguilera D. Vitamins in dialysis: who, when and how much? Renal failure. 2014 May 1;36(4):638-50.

O'Leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010 Mar;2(3):299-316.

Sutton D, Higgins B, Stevens JM. Continuous ambulatory peritoneal dialysis patients cannot increase dietary intake to recommended levels. J Renal Nutr. 2007;17(5):329-335.

Vani K, Arshi M, Jaya N. A Study of Vitamin B12 Levels In Chronic Kidney Disease Patients In Tertiary Care Hospital. IOSR Journal of Dental and Medical Sciences. 2019 Sep;18(9): 10-14

Chandna S, M, Tattersall J, E, Nevett G, Tew C, J, O’Sullivan J, Greenwood R, N, Farrington K: Low Serum Vitamin B Levels in Chronic High-Flux Haemodialysis Patients. Nephron 1997; 75:259-263.

Descombes E, Hanck AB, Fellay G. Water-soluble vitamins in chronic hemodialysis patients and need for supplementation. Kidney international. 1993 Jun 30;43(6):1319-28.

Ramirez G, Chen M, Jwr HW, Fuller SM, Ganguly R, Brueggemeyer CD, Butcher DE. Longitudinal follow–up of chronic hemodialysis patients without vitamin supplementation. Kidney international. 1986 Jul 1;30(1):99-106.

Minar E, Zazgornik J, Bayer PM, Lanschützer H, Mengele K, Marosi L. Hematologic changes in patients under long-term hemodialysis and hemofiltration treatment with particular reference to serum concentrations of folic acid and vitamin B 12). Schweiz Med Wochenschr. 1984 Jan 14;114(2):48-53.

Published

2023-12-21

How to Cite

1.
Alkrush A, Mahmood S. THE PREVALENCE OF VITAMIN B12 DEFICIENCY IN HEMODIALYSIS PATIENTS. JSMC [Internet]. 2023 Dec. 21 [cited 2024 Jul. 19];13(4):8. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10437

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