High-dose cholecalciferol to correct vitamin D deficiency in haemodialysis patients

Tokmak, Faruk; Quack, Ivo; Schieren, Gisela; Sellin, Lorenz; Rattensperger, Dirk; Holland‐Letz, Tim; Weiner, Stefan M.; Rump, Lars Christian

doi:10.1093/ndt/gfn367

Cited by 81 publications

(79 citation statements)

References 20 publications

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“…In a study published in 2008, among 64 HD patients, serum 25(OH) D level had increased by 95% with 20,000 IU of VitD3 per week for 9 months and at the end of the study, serum 25(OH) D had reached more than 30 ng/mL in 48% of patients (20). In another study performed on 107 HD patients with vitamin D deficiency, 100,000 IU of vitamin D3 was administered per month.…”

Section: Discussionmentioning

confidence: 99%

Effects of Inactive Vitamin D on Persistent Secondary Hyperparathyroidism in Patients on Hemodialysis

Jalalzadeh

Mousavinasab

2017

Nephrourol Mon

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Background: Secondary Hyperparathyroidism (sHPT) is an important feature of chronic renal failure and contributes to the development of renal osteodystrophy. This study was carried out to assess 25(OH)D status and its effect on sHPT in patients on hemodialysis (HD). Methods: A prospective experimental trial of 180 HD patients (F: 81, M: 99, age > 14year) participated in the study. At base line, levels of 25(OH)D, intact Parathyroid Hormone (iPTH), Calcium (Ca), Phosphorous (P), Alkaline phosphatase (Alk p), and albumin of serum were measured. Patients with 25(OH)D deficiency (< 30 ng/mL) were randomly divided to two groups: intervention (received 300,000 U/IM vitD3 at the beginning and after 2 months, if was necessary) and control (received placebo). After 2 and 4 months, the same biochemical markers were measured and efficacy of vitD3 on sHPT was assessed. Secondary Hyperthyroidism (sHPT) was defined as iPTH > 300 pg/mL. Results: Serum 25(OH)D levels were deficient in 87.8% (n: 158) of subjects, and normal in 12.2% (n: 22). The prevalence of sHPT, according to 25(OH)D levels, was 71.5% (n: 113)(< 30 ng/mL) and 40.9% (n: 9)(≥ 30), respectively. There were 57 intervention and 56 control subjects. In the intervention group, 2 months after injections, 25(OH)D increased from 13.85 ± 6.5 to 48.5 ± 20.7 (P < 0.001), iPTH was reduced from 567.2 ± 276.7 to 282.7 ± 183.6 (P < 0.001), calcium from 9.10 ± 0.5 to 8.76 ± 0.7 (P = 0.021), Alk p from 553.37 ± 495.6 to 393.4 ± 419.5 (P < 0.001), albumin from 3.87 ± 0.5 to 4.00 ± 0.4 (P = 0.06), and phosphorus from 4.90 ± 1.2 to 5.21 ± 1.3 (P = 0.12). Since all cases were under appropriate treatment for sHPT, there was a significant reduction on the levels of iPTH (P = 0.005) and Alk p (P = 0.049), and slight increase in 25(OH)D level (P = 0.08 ) in the control group. However, the amount of these changes was less than the intervention group. Conclusions: These findings showed that 25(OH)D insufficiency was highly prevalent in HD cases and higher amount of 25(OH)D levels prevent sHPT.

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Section: Discussionmentioning

confidence: 99%

Effects of Inactive Vitamin D on Persistent Secondary Hyperparathyroidism in Patients on Hemodialysis

Jalalzadeh

Mousavinasab

2017

Nephrourol Mon

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“…On the basis of prior research (16,19,20,24), we assumed that following treatment, 90% of participants treated with high-dose ergocalciferol, 50% of low-dose participants, and 10% of placebo participants would become 25(OH)D replete (blood levels of 25(OH)D .32 ng/ml) in 12 weeks. With use of an a of 0.05, 35 participants per arm (total, n=105) would provide 97% power for comparisons of repletion rates between groups.…”

Section: Sample Size Determinationmentioning

confidence: 99%

“…A clear cause-and-effect relationship, however, has not been established. Data are inconsistent regarding the effect of 25(OH)D on markers of mineral metabolism, and studies of nutritional vitamin D supplementation for secondary hyperparathyroidism in advanced CKD have yielded mixed results (14)(15)(16)(17)(18)(19)(20)(21). Practice patterns vary, and prospective studies examining the safety and efficacy of nutritional vitamin D replacement in ESRD have been limited.…”

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confidence: 99%

Nutritional Vitamin D Supplementation in Dialysis

Bhan¹,

Dobens²,

Tamez³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Results Baseline characteristics were similar across all arms, with overall mean6SD 25(OH)D levels of 21.966.9 ng/ml. At 12 weeks, vitamin D sufficiency (25[OH]D .32 ng/ml) was achieved in 91% (weekly), 66% (monthly), and 35% (placebo) (P,0.001). Mean 25(OH)D was significantly higher in both the weekly (49.862.3 ng/ml; P,0.001) and monthly (38.362.4 ng/ml; P=0.001) arms compared with placebo (27.462.3 ng/ml). Calcium, phosphate, parathyroid hormone levels, and active vitamin D treatment did not differ between groups. All-cause and cause-specific hospitalizations and adverse events were similar between groups during the intervention period. Lower all-cause mortality among ergocalciferol-treated participants was not statistically significant (hazard ratio, 0.28; 95% confidence interval, 0.07 to 1.19).Conclusions Oral ergocalciferol can increase 25(OH)D levels in incident hemodialysis patients without significant alterations in blood calcium, phosphate, or parathyroid hormone during a 12-week period.

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“…Although a handful of studies have reported 25 (OH)D response to cholecalciferol in dialysis patients (11)(12)(13)(14), there was little quantification of dose response or comparison with the 25(OH)D response in healthy populations with functional kidneys. The study reported here was a randomized, double-blind, placebo-controlled study of the effects of cholecalciferol supplementation on physical performance score and quality of life (data not shown) in a group of subjects on chronic hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

25-Hydroxyvitamin D Response to Cholecalciferol Supplementation in Hemodialysis

Armas

Andukuri

Barger-Lux

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Recent understanding of extrarenal production of calcitriol has led to the exploration of native vitamin D treatment in dialysis patients. This paper reports the pharmacokinetics of 25-hydroxyvitamin D response to 10,333 IU cholecalciferol given weekly in subjects on chronic dialysis. Design, setting, participants, & measurements This randomized, double-blind, placebo-controlled trial of 15 weeks of oral cholecalciferol in subjects with stage 5 CKD requiring maintenance hemodialysis was conducted from November of 2007 to March of 2010. The time course of serum 25-hydroxyvitamin D was measured over the course of treatment. Additionally, blood was drawn at baseline and last visit for calcium, phosphorus, calcitriol, and parathyroid hormone levels. Results The median (interquartile range) baseline 25-hydroxyvitamin D level was 13.3 (11.1–16.2) ng/ml for the treatment group and 15.2 (10.7–19.9) ng/ml for the placebo group. 25-hydroxyvitamin D steady state levels rose by 23.6 (19.2–29.9) ng/ml in the treatment group, and there was no change in the placebo group. Calcitriol levels also increased significantly in the treatment group. There were no significant changes in levels of calcium, albumin, phosphorus, and parathyroid hormone in either group. Conclusions Cholecalciferol (10,333 IU) given weekly in patients on chronic hemodialysis produces a steady state in 25-hydroxyvitamin D of approximately 24 ng/ml.

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High-dose cholecalciferol to correct vitamin D deficiency in haemodialysis patients

Cited by 81 publications

References 20 publications

Effects of Inactive Vitamin D on Persistent Secondary Hyperparathyroidism in Patients on Hemodialysis

Effects of Inactive Vitamin D on Persistent Secondary Hyperparathyroidism in Patients on Hemodialysis

Nutritional Vitamin D Supplementation in Dialysis

25-Hydroxyvitamin D Response to Cholecalciferol Supplementation in Hemodialysis

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