title: Impact of cholecalciferol treatment on biomarkers of inflammation and myocardial structure in hemodialysis patients without hyperparathyroidism.
abstract: BACKGROUND
  Vitamin D (25-hydroxyvitamin D, 25(OH)D) deficiency, hypovitaminosis D, is highly prevalent in chronic kidney disease patients and is potentially involved with complications in the hemodialysis (HD) population. The aim of this study was to evaluate the impact of cholecalciferol supplementation on biomarkers of mineral metabolism, inflammation, and cardiac function in a group of HD patients presenting with hypovitaminosis D and low intact parathyroid hormone (iPTH) levels.
  
  
  METHODS
  HD patients with iPTH levels of <300 pg/mL, not receiving vitamin D therapy, and presenting with 25(OH)D levels of <30 ng/mL were enrolled in this prospective study. Oral cholecalciferol was prescribed once a week in the first 12 weeks (50,000 IU) and in the last 12 weeks (20,000 IU) of the study. High-sensitivity C-reactive protein, interleukin-6, and serum albumin were used as inflammatory markers. Echocardiograms were performed on a midweek interdialytic day at baseline and after 6 months of cholecalciferol supplementation.
  
  
  RESULTS
  In all, 30 patients were included in the final analysis. We observed a significant increase in serum 25(OH)D levels after 3 months (46.2 ± 14.4 ng/mL vs. 18.1 ± 6.6 ng/mL; P < .001) and after 6 months (40.4 ± 10.4 ng/mL vs. 18.1 ± 6.6 ng/mL; P < .001) of cholecalciferol supplementation. There were no significant changes in alkaline phosphatase, iPTH, phosphorus, and serum albumin levels, but there was a slight but significant increase in calcium levels after 6 months of cholecalciferol supplementation (9.4 ± 0.6 mg/dL vs. 9.0 ± 0.6 mg/dL; P = .02). Additionally, we observed a significant reduction in high-sensitivity C-reactive protein levels after 3 months (median: 0.62 [0.05 to 29.6] mg/L vs. 0.32 [0.02 to 3.13] mg/L; P = .02) and after 6 months (median: 0.62 [0.05 to 29.6] mg/L vs. 0.50 [0.02 to 5.66] mg/L; P = .04) of cholecalciferol supplementation, as well as a significant reduction in interleukin-6 levels (median: 6.44 pg/mL vs. 3.83 pg/mL; P = .018) after 6 months of supplementation. Left ventricular mass index was significantly reduced at the end of supplementation (159 ± 55 g/m(2) vs. 175 ± 63 g/m(2); P = .03).
  
  
  CONCLUSIONS
  Cholecalciferol supplementation in HD patients was found to be safe and efficient to correct hypovitaminosis D and established little impact on mineral metabolism markers. Additionally, we observed a reduction in important surrogate markers of cardiovascular risk, namely systemic inflammation and left ventricular hypertrophy, suggesting an anti-inflammatory action and possibly an improvement of cardiac dysfunction.
authors: Renal Division, Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; Dialysis Division, Instituto do Rim do Paraná, Curitiba, Paraná, Brazil.
authors: Sérgio
authors: S
authors: Bucharles
authors: Renal Division, Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; Echocardiographic Division, Hospital Cardiológico Costantini, Curitiba, Paraná, Brazil.
authors: Silvio Henrique
authors: SH
authors: Barberato
authors: Renal Division, Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; Basic Pathology Department, Universidade Federal do Paraná, Curitiba, Brazil.
authors: Andréa E M
authors: AEM
authors: Stinghen
authors: Renal Division, Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
authors: Betina
authors: B
authors: Gruber
authors: Dialysis Division, Instituto do Rim do Paraná, Curitiba, Paraná, Brazil.
authors: Luciana
authors: L
authors: Piekala
authors: Dialysis Division, Instituto do Rim do Paraná, Curitiba, Paraná, Brazil.
authors: Ana Cláudia
authors: AC
authors: Dambiski
authors: Renal Division, Universidade Federal de Uberlandia, Brazil.
authors: Melani R
authors: MR
authors: Custodio
authors: Renal Division, Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil. Electronic address: r.pecoits@pucpr.br.
authors: Roberto
authors: R
authors: Pecoits-Filho
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D002762:Cholecalciferol / Q000008:administration & dosage*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000503:physiopathology*; D007249:Inflammation / Q000188:drug therapy; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000737:chemistry; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications / Q000503:physiopathology; D014815:Vitamins
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D010281:Parathyroid Hormone; D012709:Serum Albumin; D014815:Vitamins; D014807:Vitamin D; D002762:Cholecalciferol; D010758:Phosphorus; D002097:C-Reactive Protein; D000469:Alkaline Phosphatase; D002118:Calcium