The prevalence of hypercalcemia-associated acute kidney injury among bodybuilders and athletes

Mohammed Younus Naji Al Atbee; Hala Sami Tuama; Safa Almukhtar; Jawad Ibrahim Rasheed

Mohammed Younus Naji Al Atbee Department of Nephrology, College of Medicine, University of Basrah, Basrah, Iraq
Hala Sami Tuama Department of Family Medicine, Beradaiya Primary Health Care, Basrah, Iraq
Safa Almukhtar Department of Medicine, Hawler College of Medicine, Erbil (Hawler), Kurdistan, Iraq
Jawad Ibrahim Rasheed Department of Nephrology, Bagdad Teaching Hospital, Baghdad Medical City, Baghdad, Iraq

Keywords: vitamin D intoxication, bodybuilder/athletes, hypercalcemia, phosphate, acute kidney injury, urinary calcium

Abstract

Acute kidney injury (AKI) results in the retention of urea and other nitrogenous waste products accompanied by fluid and electrolyte deregulation that portend serious consequences. Bodybuilders and athletes frequently use a lot of dietary supplements containing non-standardized formulas of multivitamins, including vitamin D, leading to severe vitamin D intoxication along with hypercalcemia-associated AKI. To evaluate the incidence of hypercalcemia-associated AKI with vitamin D intoxication and to analyze the spectrum of causes of AKI among hospitalized patients. A cross-sectional study was conducted between June 2016 to March 2022 by recruiting eighty patients who presented with AKI and were admitted to the hospital. The patients were reviewed to ascertain the causes of AKI and a complete blood investigation was conducted for the quantitative determination of electrolytes and vitamin D. Vitamin D intoxication was diagnosed by measuring the 25 hydroxyvitamin D level, and a level beyond 150 ng/mL was considered toxic. All 16 patients affected by AKI with vitamin D intoxication were bodybuilders/athletes. They showed a strong correlation with hypercalcemia (100%), increased urinary calcium (hypercalciuria: 100%), and hypervitaminosis D (100%) but showed normal serum phosphate levels (24.2%). Renal ultrasound findings revealed renal stones (66.7%) and nephrocalcinosis (100%). This study reinforces the necessity of awareness among bodybuilders/athletes regarding the intake of unprescribed/unstandardized supplements and monitoring their renal function, vitamin D, and calcium levels. Nephrologists should be aware of the early diagnosis and treatment of AKI with vitamin D intoxication for the improvement in renal outcome.