Supplementation with Alfacalcidol increases protein intake and serum albumin concentration in patients undergoing hemodialysis with hpoalbumineamia.
BACKGROUND
We have reported that vitamin D deficiency may be implicated in the pathogenesis of hypoalbuminemia observed in patients with end-stage renal disease, but the mechanism remains to be clarified. The aim of the present study was to determine whether supplementation with alfacalcidol might increase protein intake in hemodialyzed patients with hypoalbuminemia.


METHODS
Twelve patients with hypoalbuminemia under 3.5 g/dl undergoing maintenance hemodialysis and not taking active forms of vitamin D were orally supplemented with 0.5 microg of alfacalcidol daily for 8 weeks. Normalized protein catabolic rate (nPCR), an index of protein intake, and serum concentrations of albumin, interleukin-6 (IL-6), IL-1beta, and soluble tumor necrosis factor-alpha receptor-II (sTNFR-II), an index of tumor necrosis factor-alpha activity, were determined before and after supplementation with alfacalcidol.


RESULTS
Supplementation with alfacalcidol increased nPCR from 0.96 +/- 0.20 to 1.16 +/- 0.15 g/kg/day (p < 0.005), thereby increasing serum albumin concentration from a baseline of 3.13 +/- 0.35 to 3.32 +/- 0.29 g/dl (p < 0.05). The baseline serum concentrations of sTNFR-II and IL-6 were markedly elevated, whereas those of IL-1beta were under the detection limit. Supplementation with alfacalcidol significantly decreased serum concentration of sTNFR-II from 23.8 +/- 4.38 to 19.7 +/- 3.93 ng/ml (p < 0.001) but did not alter serum IL-6 concentration.


CONCLUSIONS
Supplementation with alfacalcidol can increase protein intake and serum albumin concentration in hemodialyzed patients with hypoalbuminemia, probably through the suppressed tumor necrosis factor activity.
Yonemura
Katsuhiko
K
Hemodialysis Unit, Hamamatsu University School of Medicine, Hamamatsu, Japan. katsuh@hama-med.ac.jp
Sugiura
Takeshi
T
Yamashita
Fuyuki
F
Matsushima
Hideki
H
Hishida
Akira
A
D000368:Aged; D000369:Aged, 80 and over; D004044:Dietary Proteins / Q000378:metabolism*; D019587:Dietary Supplements; D004435:Eating / Q000187:drug effects; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000494:pharmacology* / Q000627:therapeutic use; D034141:Hypoalbuminemia / Q000188:drug therapy* / Q000209:etiology; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis / Q000187:drug effects*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000378:metabolism
D004044:Dietary Proteins; D006887:Hydroxycholecalciferols; D015850:Interleukin-6; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; C008088:alfacalcidol