Weekly high‐dose ergocalciferol to correct vitamin D deficiency/insufficiency in hemodialysis patients: A pilot trial

Abstract

Controversy exists on which vitamin D (D2 or D3) and which dosage scheme is the best to obtain and maintain adequate 25 OH D levels in dialysis patients safely. We tried to determine whether high-dose vitamin D2 supplementation could obtain optimal vitamin D status without inducing hypercalcemia. We studied 82 patients on dialysis not taking active vitamin D therapy and supplemented them with oral vitamin D2 72,000 IU/week for 12 weeks followed by 24,000 IU/week as maintenance therapy during 36 weeks. By week 12, serum 25(OH)D increased from 15.2 ± 5.4 to 42.5 ± 13.2 ng/mL (P < 0.01) at week 12 and remained optimal (34.7 ± 12.0); 84.8% of the patients reached values ≥30 ng/mL. iPTH and alkaline phosphatase did not change at 48 weeks compared with baseline, but bone alkaline phosphatase decreased significantly (54.3 ± 46.0 to 44.3 ± 25.0; P = 0.02). Uncorrected serum Ca increased significantly at the end of follow-up (9.03 ± 0.42 to 9.14 ± 0.62; P = 0.04); hypercalcemia was presented in two patients in the first control visit (week 12), in one patient in the second control (week 30), and in one patient in the third control (week 48). In 222 serum calcium determinations during follow-up, hypercalcemia was observed in only 1.8% of cases. This vitamin D2 oral regimen with initial high doses was safe and sufficient to obtain and maintain optimal serum 25(OH)D concentrations and prevent vitamin D insufficiency in chronic kidney disease patients on dialysis.

Vitamin D Supplementation Improves Quality of Life and Physical Performance in Osteoarthritis Patients

“…Del Valle et al studied a high-dose ergocalciferol 72,000 IU/week for 12 weeks and maintenance therapy 24,000 IU/week during 36 weeks in hemodialysis patients. They found that only 1.8% had hypercalcemia [ 29 ]. However, blood calcium levels are not a good reflection of calcium status, whereas urinary calcium excretion determines the risks of vitamin D treatment for excessive calcium absorption.…”

Fractures in patients with CKD—diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation

“…Table 2 summarizes the studies assessing changes in serum 25OHD and PTH with vitamin D supplementation. [76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92] Supplementation with calcidiol in CKD stage 5D improved bone mineralization but had a limited effect on reducing serum PTH similar to non-CKD patients. 93,94 Several studies have also looked at the correlation between serum vitamin D level and BMD in CKD and non-CKD populations.…”

Russian Association of Endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults

“…Вместе с тем при установленном дефиците 25(OH)D, компенсация дефицита натив-ного витамина D является обязательным этапом ле-чения и проводится, в том числе, пациентам с тер-минальной стадией почечной недостаточности [143] и диабетической нефропатией [144]. Основные пре-параты активных метаболитов витамина D и их ана-логов сведены в табл.…”