Vitamin D supplementation and recombinant human erythropoietin utilization in vitamin D-deficient hemodialysis patients.
BACKGROUND
We sought to examine the impact of ergocalciferol (ERGO) on recombinant human erythropoietin (EPO) use in a cohort of 25-OH vitamin D (25-D)-deficient hemodialysis (HD) patients.


METHODS
Baseline 25-D levels were obtained for all patients who received HD >6 months in our unit. Patients with levels between 10 and 30 ng/mL received ERGO 50,000 IU x 4 doses and patients with levels <10 ng/mL received 50,000 IU x 6 doses over a 4-month period. Monthly dose of EPO was recorded at baseline and after ERGO supplementation.


RESULTS
Baseline 25-D levels were <30 ng/mL in 89% of tested patients. Eighty-one patients were included in this study. Mean baseline 25-D level was 15.3 ± 7.1 ng/mL and increased to 28.5 ± 8.6 ng/mL after ERGO (p<0.0001), and median baseline EPO dose was 21,933 U/month (interquartile range [IQR] 13,867-35,967) and decreased to 18,400 U/month (IQR 11,050-33,000) after ERGO (p=0.17). Forty-six patients (57%) required less EPO after ERGO compared with baseline: 15,450 U/month (IQR 10,056-23,575) vs. 26,242 U/month (IQR 15,717-40,167), respectively (p<0.0001). Thirty-five patients (43%) required a higher dose of EPO after ERGO, 26,350 U/month (IQR 15,875-46,075) vs. 17,667 U/month (IQR 12,021-23,392), respectively (p=0.016). Mean age, sex, vintage, diabetes status, race and 25-D levels did not differ in these 2 groups of patients, either at baseline or after ERGO. Monthly hemoglobin, iron saturation, albumin, intact parathyroid hormone, calcium and phosphorus were unchanged after ERGO in these 2 groups.


CONCLUSIONS
ERGO use in 25-D-deficient HD patients may lessen the need for EPO. We recommend more aggressive supplementation with ERGO in future studies to achieve levels >30 ng/mL.
Kumar
Victoria A
VA
Southern California Permanente Medical Group, Los Angeles Medical Center, Los Angeles, California, USA. Victoria.a.kumar@kp.org
Kujubu
Dean A
DA
Sim
John J
JJ
Rasgon
Scott A
SA
Yang
Philip S
PS
D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D019587:Dietary Supplements; D004872:Ergocalciferols / Q000627:therapeutic use*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007505:Iron-Dextran Complex / Q000627:therapeutic use; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000628:therapy*; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011994:Recombinant Proteins; D006435:Renal Dialysis; 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*
D015415:Biomarkers; D004872:Ergocalciferols; D005290:Ferric Compounds; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D014807:Vitamin D; D007505:Iron-Dextran Complex; C104450:25-hydroxyvitamin D; C035552:ferric gluconate