Cholecalciferol Additively Reduces Serum Parathyroid Hormone and Increases Vitamin D and Cathelicidin Levels in Paricalcitol-Treated Secondary Hyperparathyroid Hemodialysis Patients.
BACKGROUND
Active Vitamin D analogues are used clinically for prevention and treatment of secondary hyperparathyroidism (SHPT) in hemodialysis (HD) patients. Nutritional vitamin D supplementation is used for additional local parathyroid (PTH) suppression, with lower incidence of hypercalcemia and hyperphosphatemia. This study evaluates the possible beneficial effects of combined vitamin D treatment (paricalcitol and cholecalciferol).


METHODS
Sixty HD patients with serum parathyroid hormone (iPTH) >300 pg/mL were enrolled. All patients administered 2 mcg/day of paricalcitol and were randomly allocated into control group (placebo) or study group (cholecalciferol) for 16 weeks. Serum 25(OH)D₃, iPTH and human cathelicidin (hCAP-18) were measured at baseline and during follow-up.


RESULTS
iPTH levels decreased in the study group appropriately and were more significantly decreased at 16 weeks. Study group had significantly increased 25(OH)D₃ levels. In addition, the study group had significantly increased serum hCAP-18 levels compared with control group. Correlation analysis showed a significant correlation between the percentage increase in serum hCAP-18 and 25(OH)D₃ levels.


CONCLUSIONS
Cholecalciferol, in combination with paricalcitol, additively lowers the iPTH levels in a significant number of patients after 16 weeks of supplementation. A dose of 5000 IU/week of cholecalciferol could maintain serum 25(OH)D₃ levels above 30 ng/dL as early as 8 weeks after beginning supplementation. Doubling of serum cathelicidin levels were noted after 16 weeks of cholecalciferol supplementation in 40% of study patients.
Division of Critical Care Medicine, Department of Emergency Medicine-Critical Care Medicine (EM-CCM), Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan. 16044@s.tmu.edu.tw.|Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. 16044@s.tmu.edu.tw.
Jing-Quan
JQ
Zheng
Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 23148, Taiwan. athletics910@gmail.com.
Yi-Chou
YC
Hou
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. 11044@s.tmu.edu.tw.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. 11044@s.tmu.edu.tw.|Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan. 11044@s.tmu.edu.tw.
Cai-Mei
CM
Zheng
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. janlin0123@gmail.com.
Chien-Lin
CL
Lu
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. wayneliu55@gmail.com.|Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 23148, Taiwan. wayneliu55@gmail.com.
Wen-Chih
WC
Liu
Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. wucc@ndmctsgh.edu.tw.
Chia-Chao
CC
Wu
Division of Critical Care Medicine, Department of Emergency Medicine-Critical Care Medicine (EM-CCM), Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan. thanthanwinnge@gmail.com.|Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan. thanthanwinnge@gmail.com.
Ming-Te
MT
Huang
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. linyf@s.tmu.edu.tw.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. linyf@s.tmu.edu.tw.|Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan. linyf@s.tmu.edu.tw.
Yuh-Feng
YF
Lin
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan. kuochenglu@gmail.com.|Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 23148, Taiwan. kuochenglu@gmail.com.|Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. kuochenglu@gmail.com.
Kuo-Cheng
KC
Lu
D000368:Aged; D023181:Antimicrobial Cationic Peptides / Q000097:blood; D002112:Calcifediol / Q000097:blood; D002762:Cholecalciferol / Q000008:administration & dosage*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004872:Ergocalciferols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010919:Placebos; D006435:Renal Dialysis; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood*; D054804:Cathelicidins
D023181:Antimicrobial Cationic Peptides; D004872:Ergocalciferols; D010281:Parathyroid Hormone; D010919:Placebos; D014807:Vitamin D; D002762:Cholecalciferol; C084656:paricalcitol; D002112:Calcifediol; D054804:Cathelicidins
cholecalciferol; human cathelicidin (hCAP-18); maintenance hemodialysis (HD); paricalcitol; secondary hyperparathyroidism (SHPT); study