Long-term cholecalciferol administration in hemodialysis patients: a single-center randomized pilot study.
BACKGROUND
Data on the potent pleiotropic extraskeletal effects of vitamin D have renewed interest in its use in selected populations, including patients with chronic kidney disease, but the available data are still insufficient to make recommendations. This study assessed the long-term effect of small cholecalciferol doses on serum vitamin D, parathormone (PTH), and bone mineral density (BMD) in hemodialysis patients.


METHODS
Nineteen patients with serum 25(OH)D <20 ng/mL were randomized into cholecalciferol (2000 IU 3×/week) and no-treatment groups, then observed for 1 year. Patients with hypercalcemia, hyperphosphatemia, and receiving vitamin D/calcimimetics were excluded. Serum 25(OH)D, 1,25(OH)2D, PTH, and alkaline phosphatase activity were examined every 2 months and BMD was measured before and after the study.


RESULTS
We observed normalization of serum 25(OH)D with an increase in medians from 11.3 to 44.9 ng/mL (P=0.02) in the cholecalciferol group and no change in the controls (P<0.001). Simultaneously, median serum 1,25(OH)2D increased from 18.2 to 43.1 pmol/L (P=0.02) in the cholecalciferol group and from 10.6 to 21.2 pmol/L (P=0.02) in controls (P=0.013). The treatment was associated with a small increase in serum calcium, but serum phosphate, PTH, alkaline phosphatase, and BMD remained unchanged in both groups.


CONCLUSIONS
Oral cholecalciferol at a dose of 2000 IU/3×/week is an effective and safe way to treat vitamin D deficiency in hemodialysis patients, leading to a significant increase in serum 1,25(OH)2D. However, it was insufficient to suppress the activity of parathyroid glands or to significantly change BMD.
Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Mariusz
M
Mieczkowski
Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Paweł
P
Żebrowski
Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Ewa
E
Wojtaszek
Department of Nephrology, Hypertension and Internal Medicine, University of Warmia and Mazury, Olsztyn, Poland.
Tomasz
T
Stompór
Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Jerzy
J
Przedlacki
Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
Zbigniew
Z
Bartoszewicz
Department of Informatics, Medical University of Warsaw, Warsaw, Poland.
Janusz
J
Sierdziński
Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
Zofia
Z
Wańkowicz
Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
Stanisław
S
Niemczyk
Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Joanna
J
Matuszkiewicz-Rowińska
D000368:Aged; D001842:Bone and Bones / Q000187:drug effects; D002112:Calcifediol / Q000097:blood; D002117:Calcitriol / Q000097:blood; D002762:Cholecalciferol / Q000008:administration & dosage* / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D006435:Renal Dialysis; D013997:Time Factors
D002762:Cholecalciferol; D002117:Calcitriol; D002112:Calcifediol