Vitamin D Status Appears Unrelated to Fractures in Patients with Chronic Kidney Disease.

Background: Although lack of Vitamin D is widespread in chronic kidney disease, data is scarce in the role Vitamin D may play in fractures in such cases. Methods: Retrospective analysis of all patients visiting Nephrology outpatients department in 1 UK District General Hospital over 2 years. Chronic kidney disease was categorised by estimated glomerular filtration rate, total Vitamin D and fracture details obtained from Hospital Information Technology system. Total Vitamin D <50nmol/L was considered inadequate. Logistic regression was used to assess the relationships of eGFR and total Vitamin D with fracture incidence. Spearman’s correlation coefficient (rs) was used to assess the relationship between continuous variables. Results: 43/66 patients were Vitamin D deficient - prevalence of Vitamin D deficiency was 65% (95% CI: 52%, 76%). 20/66 patients sustained any form of fracture, incidence of fracture in this chronic kidney disease population was 30% (95% CI: 20%, 43%). There was no association between total Vitamin D level and risk of fracture, OR 0.99 (95% CI: 0.97, 1.01), p = 0.316. The strength of the association between total Vitamin D level and fracture was also unrelated to estimated glomerular filtration level (interaction test, p = 0.971). There was no relationship between estimated glomerular filtration and total Vitamin D level (rs = -0.03, p = 0.8066). Estimated glomerular filtration was found to be negatively associated with risk of fracture, OR 0.96 (0.93, 1.00), p = 0.028. Conclusion: Vitamin D deficiency appears widely prevalent in chronic kidney disease with a third of patients sustaining fractures; total Vitamin D levels however are unrelated to fractures. Prospective interventional studies can help answer if earlier replacement of Vitamin D before chronic kidney disease develops will help improve musculoskeletal health and prevent fractures.

Prevalence of depression and its effect on disability in patients with age-related macular degeneration.

Aims: To estimate depression in patients with age-related macular degeneration (AMD) and study the relationships among depression, visual acuity, and disability. Materials and Methods: It was a cross-sectional study with consecutive sampling (n = 53) of patients with AMD aged 50 years and above attending the retina clinic of a tertiary care hospital in North India. Depression, general disability and vision-specific disability were assessed in subjects meeting selection criteria. Assessments were done using the fourth edition of Diagnostic and Statistical Manual of mental disorders (DSM- IV) Geriatric Depression Scale (GDS), Structured Clinical Interview for DSM-IV Axis -I Disorders, Clinical Version (SCID-CV), World Health Organization Disability Assessment Schedule-II (WHODAS-II) and Daily Living Tasks dependent on Vision scale (DLTV). Non-parametric correlation analyses and regression analyses were performed. Results: Out of 53 participants, 26.4% (n = 14) met DSM-IV criteria for the diagnosis of depressive disorder. Depressed patients had significantly greater levels of general and vision-specific disability than non-depressed patients. General disability was predicted better by depression and vision-specific disability than by visual acuity. Conclusion: Depression is a major concern in patients with AMD and contributes more to disability than visual impairment.