title: Ergocalciferol treatment does Not improve erythropoietin utilization and hospitalization rate in hemodialysis patients.
abstract: Vitamin D (25-hydroxyvitamin D; 25[OH]D) deficiency (VDD) is highly prevalent in chronic kidney disease. The aim of this study was to evaluate the effect of oral ergocalciferol supplementation on requirement of erythropoietin (EPO) and active vitamin D analogues, and hospitalization rate in maintenance hemodialysis (HD) patients.
  
  
  
  This retrospective cohort study included 186 patients who were on HD for 3 months and had 25(OH)D levels < 30 ng/ml. Over 1-year period, 107 patients were supplemented with protocol-based ergocalciferol (D2group) and 79 were not (control). Parameters of erythropoiesis and bone-mineral metabolism, and monthly doses of EPO and paricalcitol were assessed at 6- and 12- months of ergocalciferol supplementation. Total hospitalizations were recorded for the same year.
  
  
  
  Baseline characteristics were similar across two arms except higher serum ferritin, transferrin saturation and prevalence of stroke in D2 and higher coronary artery disease in control group with overall mean ± SD 25(OH)D level of 16.8 ± 7 ng/ml. At 12 months, 25(OH)D levels increased significantly in D2group compared to control (30.5 ± 11.7 vs. 14.2 ± 9.3 ng/ml; p < 0.001). The EPO dose remained same with no difference in hemoglobin values between the two groups during the intervention period. On multivariate regression which included above variables there was no effect of ergocalciferol treatment on EPO dose (p = ns). Hospitalization rate was similar in two arms; however, ergocalciferol treatment inversely associated with paricalcitol dose (β ± SE = -10.4 ± 2.8; p < 0.001).
  
  
  
  One-year of ergocalciferol supplementation was not associated with reduction in EPO requirement or hospitalization rate in HD patients with VDD. Further studies are warranted to determine definitive role of nutritional vitamin D in these patients.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, Division of Nephrology, University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX, 78229, USA.
authors.forename: Padam
authors.initials: P
authors.lastname: Hirachan
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gelfond
authors.affiliation: Department of Medicine, Division of Nephrology, University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX, 78229, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fanti
authors.affiliation: Department of Medicine, Division of Nephrology, University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX, 78229, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Hura
authors.affiliation: Department of Medicine, Division of Nephrology, University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX, 78229, USA. bansals3@uthscsa.edu.|Renal Section, South Texas Veterans HealthCare System, San Antonio, TX, USA. bansals3@uthscsa.edu.
authors.forename: Shweta
authors.initials: S
authors.lastname: Bansal
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004872:Ergocalciferols / Q000008:administration & dosage*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000639:trends*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood; D014815:Vitamins / Q000008:administration & dosage / Q000097:blood
chemical_list: C554270:EPO protein, human; D004872:Ergocalciferols; D014815:Vitamins; D004921:Erythropoietin; D014807:Vitamin D
keywords: EPO requirement; Ergocalciferol; Hemodialysis; Hospitalization; Vitamin D deficiency