Vitamin A deficiency after prolonged intake of an unbalanced diet in a Japanese hemodialysis patient

• Published in: Documenta ophthalmologica 2021-08, Vol.143 (1), p.85-91
• Main Authors: Kishimoto, Nanami, Hayashi, Takaaki, Mizobuchi, Kei, Kubota, Masaomi, Nakano, Tadashi
• Format: Article
• Language: English
• Subjects: Acuity; Blindness; Clinical Case Report; Dark Adaptation; Diet; Electroretinograms; Electroretinography; Gastrointestinal surgery; Hemodialysis; Humans; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Nutrient deficiency; Nyctalopia; Ophthalmology; Palmitic acid; Patients; Photic Stimulation; Renal Dialysis - adverse effects; Surgery; Undernutrition; Visual Acuity; Vitamin A; Vitamin A Deficiency - diagnosis; Vitamin A Deficiency - drug therapy; Vitamin A Deficiency - etiology
• ISSN: 0012-4486; 1573-2622
• DOI: 10.1007/s10633-021-09823-1

Background In industrialized countries, vitamin A deficiency (VAD) is extremely rare, except association with bariatric surgeries and hepatobiliary disorders. It is unusual that VAD develops during hemodialysis due to reduced glomerular filtration of vitamin A-binding protein. We reported the case of a 58-year-old Japanese male hemodialysis patient diagnosed with VAD. Case presentation The patient undergoing hemodialysis for more than 15 years presented with progressive photophobia and night blindness and was ophthalmologically examined. He denied a history of cancer or hepatobiliary disease and reported that he loved eating prepackaged noodle bowls and foods, with prolonged low intake of fruits/vegetables. He had good visual acuity. Fundus images showed numerous white dots in the midperipheral retinae, but no degenerative changes. In baseline full-field electroretinography (ERG), b-wave responses were extremely reduced in rod ERG, a-wave amplitudes in standard-flash/strong-flash ERG were reduced to 20–25% of our controls, a- and b-wave amplitudes in cone ERG were reduced to 40–50% of the controls. Whole-exome sequencing identified no pathogenic variant for any inherited retinal disorder. He was diagnosed with VAD because of reduced serum vitamin A levels and treated with retinol palmitate. Two months after treatment commencement, the serum vitamin A level was within the normal range. Full-field ERG showed that the scotopic ERG responses markedly improved compared with baseline. Conclusions This is the first report of VAD associated with undernutrition in the Japanese hemodialysis population.