Efficacy of 25 (OH) Vitamin D Supplementation and Physical Activity in Improving Musculoskeletal Health in Individuals with Chronic Kidney Disease (CKD). A Multicenter Randomized, Controlled Trial.

Abstract

Aims: We investigated the role of vitamin D (VD) and targeted physical activity in improving musculoskeletal health among chronic kidney diseases (CKD) patients. Methods: An open-label, randomized controlled trial of VD replacement in stage 2-4 CKD patients, attending two nephrology clinics of Karachi, Pakistan was undertaken. 2,637 subjects were contacted, 115 found to be deficient for 25 hydroxyvitamin D (25 OHD) levels were block randomized to either 4,000 IU of daily oral vitamin D3 (cholecalciferol) or combination of daily drops along with targeted physical therapy for 3 months. A predesigned questionnaire along with IPAQ was administered to assess the physical activity. Baseline biochemical testing for calcium, Phosphate, bone alkaline phosphatse, iPTH were performed. Musculoskeletal health was assessed by trained physical therapist by measuring bicep strength, back flexibility and fat composition and hand grip assessment. The outcome was improvement in musculoskeletal health to be assessed by plasma iPTH, calcium, bone specific alkaline phosphatase and hand grip strength assessment and improvement in serum 25OHD levels. Analysis was by intention to treat. Results: Of the 115 VD deficient subjects enrolled at baseline, 42 were lost to follow-up (47 % in VD alone vs. 52 % in vitamin along with physical activity group). The mean 25OHD level at the baseline was comparable in both the arms. At follow-up, 25OHD status was 85.0±8.9 nmol/L in the VD group and 95.8±6.6 nmol/L in VD along with physical activity group. There was significant improvement in the musculoskeletal health in the second arm compared to VD alone as well as within the group improvement (p value ≤ 0.03). Conclusions: Treatment with both VD and targeted physical activity was found to be effective for improvingmusculoskeletal health (strength, muscle force, or power) in CKD patients.