Active Vitamin D in Chronic Kidney Disease: Getting Right Back Where We Started from?

Negrea, Lavinia

doi:10.1159/000495138

Cited by 20 publications

(18 citation statements)

References 75 publications

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“…The association between vitamin D and CKD is well established [ 52 , 53 ]. However, sensitivity analysis did not identify an effect modification by CKD on the vitamin D–study outcome link.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

et al. 2021

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Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67–0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

et al. 2021

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“…[80]. These drugs can also be used with caution when there are continuing trends to increased PTH in CKD stages 4 and 5 [67,102]. The use of one-alfa calcidol has been shown to improve bone histology in CKD 4 and has similar activity to calcitriol in CKD-5D [80].…”

Section: Management Of Biochemical Abnormalities Of Ckd-mbdmentioning

confidence: 99%

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

et al. 2021

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This article aims to review the methods used for the assessment of fracture risk and the use of osteoporosis medications for fracture prevention in the population with CKD, and highlights the difficulties faced by clinicians in the management of these patients and the latest recommendations and guidelines. Chronic kidney disease (CKD) and osteoporosis often co-exist in older adults, and they present a major healthcare challenge. CKD mineral and bone disorder (CKD-MBD) occurs as renal function declines and this syndrome affects most patients in CKD stages 4 and 5. The biochemical abnormalities of CKD-MBD, renal bone disease and risk factors associated with age-related bone loss and osteoporosis lead to a cumulative effect on fracture risk and mortality. There is a need for routine evaluation of fracture risk and fracture prevention in this population. Measurement of bone mineral density (BMD) and the use of the FRAX tool have predictive value for incident fractures in the general population and in CKD. This enables physicians to identify CKD patients most at risk of sustaining a fragility fracture and allows a more targeted approach to fracture prevention. Data analysis from the pivotal trials of therapeutic agents used in osteoporosis show that these drugs can be considered in mild and moderate CKD (stages 1–3 CKD). Off-label drug use in patients with CKD-MBD and more severe renal impairment (CKD stages 4 and 5) could offer significant benefits to sub-groups of patients when carefully tailored to each individual’s bone turnover and calcium and phosphate balance. However, this requires a selective approach and treatment decisions based on inference from pathophysiology while we await further trials. Guidelines advocate the correction and/or reduction of the biochemical abnormalities of CKD-MBD before initiation of treatment with osteoporosis drugs and close monitoring during treatment.

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“…In kidney disease, calcitriol levels eventually decrease, resulting in the development of secondary hyperparathyroidism (SHPT). 5 This randomized control crossover study was designed to observe the clinical effects of two vitamin D analogs and compare their efficacy in terms of treating secondary hyperparathyroidism in the dialysis population. Paricalcitol is a relatively new drug and still, it is not widely available in the market.…”

Section: Discussionmentioning

confidence: 99%

“…Management of bone mineral disease in dialysis patients sometimes becomes difficult as clinicians face the challenge of treating secondary hyperparathyroidism while keeping calcium and phosphate within normal ranges. 1 Vitamin D analogues are the usual treatment of choice for suppressing PTH levels as it can treat underlying hypocalcemia as well. 1, 25 dihydroxycholecalciferol (calcitriol) is the active form of vitamin D and it not only stimulates the phosphate and calcium reabsorption from the gut but also plays a vital role in bone resorption and bone formation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Paricalcitol (I.V) and Alfacalcidol (I.V) in Treatment of Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients

Qaisar¹,

Abideen²,

Chattah³

et al. 2020

JRMC

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ABSTRACT Objective of study: To Compare the efficacy of Alfacalcidol (I.V) and Paricalcitol (I.V) for the treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients. Materials and Methods: An open-label randomized clinical trial carried out to compare the efficacy of intravenous paricalcitol and alfacalcidol. We recruited 80 patients with end stage renal disease receiving maintenance hemodialysis in a tertiary care hospital dialysis unit. The participants were randomly divided into two groups. A wash out period of one week was decided for each patient in which he/she did not receive any medication for treatment of hypocalcemia, hyperphosphatemia or secondary hyperparathyroidism. Afterwards, patients received expanding dosage of alfacalcidol or paricalcitol for a time of about four months and then after a further wash out period of one week, each group received opposite treatment (paricalcitol or alfacalcidol) for further four months (16 weeks). Results: The analyzed data for the same end points revealed no difference between the two groups. No significant statistical difference in terms of calcium levels in both groups was noted. The study also found no big difference in the ability of both drugs to treat secondary hyperparathyroidism, while keeping serum phosphate and calcium levels inside the desired range. The study also found no distinction in the frequency of hypercalcemia and hyperphosphatemia as a side effect of Vitamin D analogue’s treatment. Conclusion: The study concludes that alfacalcidol and paricalcitol are equally effective in treatment of secondary hyperparathyroidism in dialysis population. Since Paricalcitol is expensive as compared to alfacalcidol, in an economically challenged country like Pakistan, Alfacalcidol can be a better choice when treating SHPT as we did not find any gross difference in the ability of two drugs to restrict SHPT. Keywords: Alfacalcidol, Paricalcitol, Secondary hyperparathyroidism, Hemodialysis.

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Active Vitamin D in Chronic Kidney Disease: Getting Right Back Where We Started from?

Cited by 20 publications

References 75 publications

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

Comparison of Paricalcitol (I.V) and Alfacalcidol (I.V) in Treatment of Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients

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