title: The effects of short-term vitamin D supplementation on glucose metabolism in dialysis patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We tested whether short-term vitamin D supplementation improves insulin resistance in patients with kidney disease, a condition with little intrinsic vitamin D activity.
  
  
  METHODS
  PubMed, EMBASE and CENTRAL were searched for relevant observational studies and randomized clinical trials (RCTs). Random-effects models were employed for meta-analysis, and effect sizes were summarized as standardized mean difference (SMD) with 95% confidence intervals. Separate analyses were done for RCTs and non-randomized intervention studies (NRIS).
  
  
  RESULTS
  Seventeen studies (5 RCTs and 12 NRIS) were included. The meta-analysis population (n = 131) was mostly middle aged (40-50 years), male and non-diabetic, and on hemodialysis. The duration (4-12 weeks) and type of supplementation varied between studies. Among RCTs, compared to placebo, vitamin D supplementation was associated with significant decrease in fasting glucose [SMD -1.13, (-2.11 to -0.11)] and PTH levels [SMD -1.50, (-2.95 to -0.04)] but no difference in fasting insulin levels [SMD 1.32, (-0.15 to 2.79)]. Among NRIS, there was only a significant decrease in PTH levels [SMD -1.68, (-2.55 to -0.82)] between pre- and post-vitamin D treatment levels.
  
  
  CONCLUSIONS
  Short-term (4-12 weeks) supplementation with vitamin D is associated with lower fasting glucose levels in ESRD with no change in fasting insulin levels. However, the findings from this study are limited by the studies that were used in the meta-analysis, which were mostly small, used multiple different vitamin D compounds and dosing regimens, and had large heterogeneity, and funnel plots showed that there was a dearth of studies with null or negative finding. Therefore, larger RCTs need to be performed to answer this important clinical question.
authors: Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA.
authors: Harini
authors: H
authors: Sarathy
authors: Vedatrayee
authors: V
authors: Pramanik
authors: Jared
authors: J
authors: Kahn
authors: Matthew K
authors: MK
authors: Abramowitz
authors: Kristen
authors: K
authors: Meier
authors: Preeti
authors: P
authors: Kishore
authors: Michal L
authors: ML
authors: Melamed
mesh_terms: D001786:Blood Glucose / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy; D010281:Parathyroid Hormone / Q000097:blood; D006435:Renal Dialysis; D013997:Time Factors; D014807:Vitamin D / Q000008:administration & dosage*
chemical_list: D001786:Blood Glucose; D050071:Bone Density Conservation Agents; D007328:Insulin; D010281:Parathyroid Hormone; D014807:Vitamin D
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