Effect of Depot Oral Cholecalciferol Treatment on Secondary Hyperparathyroidism in Stage 3 and Stage 4 Chronic Kidney Diseases Patients

Abstract

By the time patients require dialysis replacement therapy, nearly all chronic kidney diseases (CKD) patients are affected with uremic bone diseases. High-turnover osteodystrophy can be prevented; patients with CKD should be monitored for imbalances in calcidiol (25 OH vitamin D), calcium, and phosphate homeostasis. We aimed to determine the effect of a monthly oral 300,000 IU vitamin D 3 (cholecalciferol) supplementation on the uremic bone diseases (UBD) markers such as iPTH and alkaline phosphatase in CKD patients. Among a total of 70 patients under treatment in the nephrology unit, 40 predialysis CKD patients (mean age of 49 ± 14, male/female 20/20) were included the study. The patients were randomly divided into two groups. Treatment group included 20 patients (mean age of 51 ± 14, male/female 9/11), and the control group comprised 20 patients (mean age of 47 ± 14, male/female 9/11). Treatment group patients were given a single dose of Devit3 ampoule (300,000 U cholecalciferol) per month orally way. Patients in the control group did not take any vitamin D for a month. The level of calcidiol was lower than normal range in two groups. After a month, treatment group patient's calcidiol increased statistically significant (6.8 ± 3.5 to 17.8 ± 21.4 ng/mL, p < 0.001). After a month, iPTH level decreased in the treatment group statistically significantly (368 ± 274 to 279 ± 179 pg/ml, p < 0.001). At the 30 th day of the treatment, in 9/20 of the treatment group patients (45%), the iPTH value decreased at least 30% (p < 0.001). We suggest that oral depot cholecalciferol treatment causes a statistically significant decrease of serum iPTH level but does not cause a statistically significant change in Ca, P, ratio of Ca×P, or urinary calcium creatinine rate in UBD predialysis CKD. This treatment can be used safely for the predialysis CKD patients, along with the cautious control of serum calcium and phosphor.

Vitamin D Supplementation in Chronic Kidney Disease

“…The combined search of MEDLINE, SCOPUS, and nephrology conference proceedings identified 3846 citations, of which 3701 were excluded after title and abstract review. Full-text assessment of 145 potentially relevant articles identified 22 studies (5 RCTs [see references [23][24][25][26][27] and 17 observational studies [see references 19,20,28 -42]) enrolling 1593 patients. Nine of the 11 authors who were contacted for additional data or clarification responded.…”

Nutritional Vitamin D Supplementation in Dialysis

“…Similarly, Kovesdy et al found no benefit for control of PTH with ergocalciferol in patients with stages 3-4 CKD (26). In contrast, Dogan et al found that large 300,000 IU bolus of cholecalciferol significantly reduced PTH in stages 3-4 CKD (versus no intervention), but follow-up was limited to 1 month (27). A larger study by Oksa et al compared 5000 IU versus 20,000 IU of cholecalciferol and found the larger dose was more effective in suppressing PTH, but this study included CKD stages as early as 2-4 (28).…”

Relationship of circulating levels of 25(OH)D with parathyroid hormone in various stages of chronic kidney disease

“…Researchers have shown that increasing serum 25(OH) D concentrations by administration of cholecalciferol can reduce serum PTH levels (20)(21)(22)(23). However, Kovesdy et al believes inactive vitamin D cannot reduce PTH levels (24).…”