Impact of a replacement algorithm for vitamin D deficiency in adult hematopoietic stem cell transplant patients Journal Article

Authors: Kenny, S. A.; Collum, K.; Featherstone, C. A.; Farooki, A.; Jakubowski, A.
Article Title: Impact of a replacement algorithm for vitamin D deficiency in adult hematopoietic stem cell transplant patients
Abstract: Adults undergoing hematopoietic stem cell transplant (HSCT) are at risk for vitamin D deficiency. After HSCT, exposure to sunlight is restricted, and patients may experience poor nutrition and malabsorption from HSCT-related side effects. Vitamin D affects bone health and immunologic processes. The aim of this project is to establish a process for monitoring and treating vitamin D deficiency and to evaluate if therapeutic vitamin D levels are attainable posttransplant using an HSCT vitamin D replacement algorithm. A multidisciplinary group led by advanced practice providers established a workflow for monitoring and supplementing vitamin D and created an HSCT vitamin D replacement guideline. The medical records of 144 adult HSCT patients were reviewed, and the records of another 72 patients were reviewed a year later. Historical baseline data before the intervention found that 81% of patients were vitamin D deficient and 30% received supplementation. Postintervention and at 1-year follow-up, 76% and 65% of patients were vitamin D deficient before transplant and 97.1% and 100%, respectively, received supplementation for vitamin D deficiency. Post-HSCT compliance with monitoring demonstrated that approximately 91% of patients had a vitamin D level checked within 6 months of transplant. After implementation of the algorithm, there was a statistically significant difference (p < .001) between deficient vitamin D levels pretransplant (72.9%) and posttransplant (26.4%). Results demonstrate sustained compliance over a 2-year period with monitoring and supplementation of vitamin D pre- and peritransplant. Aggressive vitamin D repletion posttransplant decreased the incidence of vitamin D deficiency in HSCT patients. Further study is needed to investigate the long-term effects of vitamin D repletion on posttransplant complications.
Keywords: adult; hematopoietic stem cell transplantation; algorithms; statistical significance; multidisciplinary care team; workflow; postoperative complications -- prevention and control; human; dietary supplementation; advanced practice nurses; vitamin d deficiency -- therapy
Journal Title: Journal of the Advanced Practitioner in Oncology
Volume: 10
Issue: 2
ISSN: 2150-0878
Publisher: Harborside Press  
Date Published: 2019-03-01
Start Page: 109
End Page: 118
Language: English
ACCESSION: 135581409
DOI: 10.6004/jadpro.2019.10.2.2
Notes: Article -- Source: cin20
Altmetric Score
MSK Authors
  1. Azeez Farooki
    41 Farooki
  2. Karen Collum
    8 Collum
  3. Sheila A Kenny
    5 Kenny