Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters.
OBJECTIVE
Vitamin D deficiency is highly prevalent in chronic kidney disease. The aim of this study was to evaluate the effects of oral cholecalciferol supplementation on mineral metabolism, inflammation, and cardiac dimension parameters in long-term hemodialysis (HD) patients.


METHODS
This 1-year prospective study included 158 HD patients. Serum levels of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D], intact parathyroid hormone, and plasma brain natriuretic peptide as well as circulating bone metabolism and inflammation parameters were measured before and after supplementation. Baseline 25(OH)D and 1,25(OH)(2)D levels were measured twice (end of winter and of summer, respectively). Therapy with paricalcitol, sevelamer, and darbepoietin was evaluated.


RESULTS
There was an increase in serum 25(OH)D and 1,25(OH)(2)D levels after supplementation. Conversely, serum calcium, phosphorus, and intact parathyroid hormone were decreased. There was a reduction in the dosage and in the number of patients who were treated with paricalcitol and sevelamer. Darbepoietin use was also reduced, with no modification of hemoglobin values. Serum albumin increased and C-reactive protein decreased during the study. Brain natriuretic peptide levels and left ventricular mass index were significantly reduced at the end of the supplementation.


CONCLUSIONS
Oral cholecalciferol supplementation in HD patients seems to be an easy and cost-effective therapeutic measure. It allows reduction of vitamin D deficiency, better control of mineral metabolism with less use of active vitamin D, attenuation of inflammation, reduced dosing of erythropoiesis-stimulating agents, and possibly improvement of cardiac dysfunction.
Matias
Patrícia João
PJ
Hemodial-Dialysis Unit, Quinta da Mina, Lote 3 r/c, 2600-063 Vila Franca de Xira, Portugal. patriciajoaomatias@gmail.com
Jorge
Cristina
C
Ferreira
Carina
C
Borges
Marília
M
Aires
Inês
I
Amaral
Tiago
T
Gil
Célia
C
Cortez
José
J
Ferreira
Aníbal
A
D000284:Administration, Oral; D000368:Aged; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D016723:Bone Remodeling / Q000187:drug effects*; D002097:C-Reactive Protein / Q000378:metabolism; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000627:therapeutic use; D002762:Cholecalciferol / Q000008:administration & dosage*; D002908:Chronic Disease; D000068256:Darbepoetin alfa; D019587:Dietary Supplements; D004872:Ergocalciferols / Q000627:therapeutic use; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood*; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011073:Polyamines / Q000627:therapeutic use; D011446:Prospective Studies; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism; D000069603:Sevelamer; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D014815:Vitamins / Q000008:administration & dosage*
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D002614:Chelating Agents; D004872:Ergocalciferols; D006397:Hematinics; D018836:Inflammation Mediators; C470125:PTH protein, human; D010281:Parathyroid Hormone; D011073:Polyamines; D012709:Serum Albumin; D014815:Vitamins; D004921:Erythropoietin; D020097:Natriuretic Peptide, Brain; D014807:Vitamin D; D000068256:Darbepoetin alfa; D002762:Cholecalciferol; D010758:Phosphorus; C084656:paricalcitol; D002097:C-Reactive Protein; D000069603:Sevelamer; C104450:25-hydroxyvitamin D; D002117:Calcitriol; D002118:Calcium