title: Supplementation with Alfacalcidol increases protein intake and serum albumin concentration in patients undergoing hemodialysis with hpoalbumineamia.
abstract: 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.
authors.affiliation: Hemodialysis Unit, Hamamatsu University School of Medicine, Hamamatsu, Japan. katsuh@hama-med.ac.jp
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yonemura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugiura
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Yamashita
authors.forename: Hideki
authors.initials: H
authors.lastname: Matsushima
authors.forename: Akira
authors.initials: A
authors.lastname: Hishida
mesh_terms: 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
chemical_list: D004044:Dietary Proteins; D006887:Hydroxycholecalciferols; D015850:Interleukin-6; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; C008088:alfacalcidol