Relationship of Different Hormone levelsand Effect of six-month Cholecalciferol Supplementationin Sarcopenic End-Stage Kidney Disease: A prospective interventional study

Abstract Background: Hormonal relationship especially effect of long-term vitamin D supplementation to sarcopenic patients is understudied. This study investigatedassociated risk factors and correlation of different hormones with sarcopenia. Further, effects of six-month cholecalciferol supplementation and quality of life were also studied. Methodology: CKD5 patients aged 18–60 years were screened for sarcopenia using handgrip strength and bioimpedance-based muscle mass. Sarcopenia was classified as probable, confirmed, and severe categories. Confirmed sarcopenic cases were supplemented with 60,000 IU weekly cholecalciferol for 12 weeks in vitamin D deficit and fortnightly for 6 weeks in sufficient patients. Comprehensive nine hormonal profile and risk factor assessment in all sarcopenic patients were done. All were subjected for QoL by KDQOL-36 SF at baseline and 6 months. Changes in Sarcopenia, physical and mental domains of QoL (PCS and MCS) were studied at baseline and 6th month. Results: Of 401 patients, sarcopenia prevalence as probable, confirmed and severe were 333 (82.29%), 134(33.4%) and 124(25.44%) respectively with higher prevalence in dialysis patients.Vitamin D supplementation showed improvement in confirmed and severe sarcopenia at 3rd month (13.1 %.and 41.1%) and 6th month (23/3% and 66.9%) respectively (p = 0.001). Vitamin D levels deficiency significantly reduced from 80.6% at baseline to 45.5% after supplementation.At six months among non-responder sarcopenic patients exhibited greaterbaseline hormonal abnormalities like high insulin resistance, hyperprolactinemia, lower T3 levels, whereas responder had better baseline muscle strength/mass and higher vitamin D levels. Among non-responder who were still vitamin D deficient showed positive correlation of vitamin D deficiency with IGF-1, testosterone deficiency and negative correlation with insulin resistance was seen. Overall, IGF-1deficiency, insulin resistance,subclinical hypothyroidism, hypogonadism, hyperprolactinemia, were highly prevalent in sarcopenic patients. KDQOL-36 scores improved significantly in mean PCS(p=0.004) and MCS (p = 0.003) after vitamin D supplementation. Diabetes and vitamin D deficiency were determined as risk factor of sarcopenia. Conclusion: Diabetes and vitamin D deficiency are risk factor for sarcopenic CKD5 patients. Six months vitamin D supplementation improved sarcopenia and quality of life in them. Non responsive sarcopenic patients had hormonal imbalances which remain uncorrected or may have blunted therapeutic effects of vitamin D. Trial registration: CTRI/2025/08/092512 –dated 6th august 2025 (retrospectively registered)