Primary Article Rachel Knepp (Article 1) Pecovnik-Balon, B., Jakopin, E., Bevc, S., Knehtl, M., & Gorenjak, M. (2009). Vitamin D as a novel nontraditional risk factor for mortality in hemodialysis patients. Therapeutic Apheresis And Dialysis: Official Peer- Reviewed Journal Of The International Society For Apheresis, The Japanese Society For Apheresis, The Japanese Society For Dialysis Therapy, 13(4), Retrieved from MEDLINE with Full Text database. Design – Cross Sectional – Observational Number of subjects – Initial: 102 (57 men, 45 women) – Final Attrition: 102 (27 died, 75 alive)

Primary Article Cont. Rachel Knepp (Article 1) Recruitment – Hemodialysis (HD) patients treated at The Department of Hemodialysis at the University Clinical center Maribor; located in Slovenia. Inclusion Criteria – Must be on hemodialysis being treated the University Clinical center Maribor Exclusion Criteria – Not listed in study

Primary Article: Results Rachel Knepp (Article 1) Data Analysis: – SPSS version 12.0, Paired and Independent t-tests, – Kaplan Meier Survival Curves, Cox Regression Model – P-value <.05 was significant Vitamin D LevelNumber of patients Sufficient25.5% (N= 26) Mild37.3% (N=38) Insufficient35.5% (N=36) Severe2% (N=2)

Primary Article: Results Rachel Knepp (Article 1) 52% of patients had 25D levels > 50 nmol/L, 48% of patients 25D levels from 10.5 to 50 nmol/L. B Pecˇovnik-Balon et al.

Primary Article: Findings Rachel Knepp (Article 1) Limitations of this Study include: – Convenient Sample – No exclusion criteria – Diagnostic Study – Statistical Analysis – All-cause mortality

Primary Article: Conclusions Rachel Knepp (Article 1) Vitamin D deficiency in HD patients is a serious condition that is often underdiagnosed, and goes un-recognized by practitioners. According this study, most HD patients have vitamin D insufficiency. Treatment for vitamin D deficiency will provide benefit to HD patients.

Primary Article: My Conclusion Rachel Knepp (Article 1) Lack of detail Recognizing Vitamin D deficiency in HD patients is important. Registered Dietitians role More research is needed to determine the degree and prevalence of vitamin D deficiency in hemodialysis patients.

Primary Article Rachel Knepp (Article 2) Taskapan H, Ersoy F, Passadakis P, et al. Severe vitamin D deficiency in chronic renal failure patients on peritoneal dialysis. Clinical Nephrology [serial online]. October 2006;66(4): Available from: MEDLINE with Full Text, Ipswich, MA. Accessed November 23, Design – Cross-Sectional Funding – Akdeniz University Research Fund Number of Subjects – Initial: 273 (123 female, 150 male) – Final: 273

Primary Article Cont. Rachel Knepp (Article 2) Recruitment – Convenient Sample from 20 Centers around Greece and Turkey. Inclusion – 20 years of older, both genders, on PD > 1 year Exclusion – Hemodialysis for longer than 2 months during the previous year – Peritonitis with 1 month of the beginning of the study – Hx of parathyroidectomy, – Hx of aluminum containing medications – Corticosteroids > 3 months.

Primary Article: Results Rachel Knepp (article 2) Statistical Analysis – Statistical tests, Correlation and linear regression, Pearsons Chi-sqaure tests and Spearman rank tests, 2- tailored Fisher’s exact tests and Mann-Whitney rank-sum tests 53 patients had diabetes mellitus, 215 had non-diabetes mellitus Patients with DM had lower levels of vitamin d than patients with non-diabetes mellitus. (p-value <.05) No significant difference in vitamin D between males and females Significant differences of vitamin D levels between participants on active vitamin D and not on active vitamin D.

Primary Article: Results Rachel Knepp (Article 2)

Primary Articles: Results Rachel Knepp (article 2)

Primary Article: Findings Rachel Knepp (Article 2) Limitations – Bias – Duration – Developing Countries and Ethics – Confounding Factors

Primary Article: Conclusion Rachel Knepp (article 2) High prevalence of (92%) of PD patients have vitamin deficiency; half had severe vitamin D deficiency Vitamin D deficiency is higher in diabetes mellitus patients than non-diabetes patients Question: Should we begin vitamin D deficiency on iPTH levels as recommended by K-DOQI or according to vitamin D levels? Explore and research more on vitamin D levels of dialysis patients

Primary Article: My Conclusion Rachel Knepp (Article 2) Questionable validity of article due to bias Vitamin D deficiency is important to recognize in PD patients Further studies need to be completed to establish optimal treatment levels Important role for Registered Dieticians