Evaluation of Responses to Vitamin D3 (Cholecalciferol) in Patients on Dialysis: A Systematic Review and Meta-Analysis

Abstract

Vitamin D plays a key role in mineral metabolism and its deficiency is often noted in patients on dialysis for end-stage renal disease (ESRD). We evaluated the efficacy and responses to vitamin D3 (cholecalciferol) in patients undergoing dialysis for ESRD. Randomized controlled trials or prospective studies comparing vitamin D3 supplementation to placebo in patients with ESRD on dialysis were searched from medical databases using the terms, 'Calcitriol/Cholecalciferol, vitamin D, chronic kidney disease, hemodialysis, serum calcium, parathyroid hormones (PTH), phosphorus, 25(OH)D, and 1,25(OH)2D'. The outcomes analyzed were serum calcium, PTH, phosphorus, 25(OH)D, and 1,25(OH) 2D levels. Of the 259 records identified, 9 studies with a total of 368 patients were chosen for the current meta-analysis. The number of patients, age, and gender distribution among the groups were comparable. Results reveal a greater increase in both 25(OH)D (Pooled difference in means=0.434, 95% CI 0.174 to 0.694, p=0.001) and 1,25(OH) 2D (Pooled difference in means=0.978, 95% CI 0.615 to 1.34, p<0.001) in the treatment arm, as compared to the placebo. There was no difference in the serum calcium or PTH among the two groups. However, patients in the treatment arm had a significant increase in phosphorus levels (Pooled difference in means=0.434, 95% CI 0.174 to 0.694, p=0.001). Vitamin D supplementation facilitated the maintenance of increased levels of 25(OH) D and 1,25(OH) 2D in patients undergoing dialysis for ESRD. This increase in vitamin D was not associated with hypercalcemia or significant changes in PTH levels.

Hypovitaminosis D: Is It Time to Consider the Use of Calcifediol?

“…In subjects with SHPT due to vitamin D deficiency, supplementation with appropriate doses of calcifediol, cholecalciferol, or ergocalciferol was able to normalize the levels of 25(OH)D and PTH [74,75,76], although the evidence on the use of calcifediol was limited.…”

Comparison of high-flux hemodialysis with hemodialysis filtration in treatment of uraemic pruritus: a randomized controlled trial

“…The BUN and creatinine are ideal for evaluation of renal function in renal diseases including ESRD [36]. The metabolism disorders in calcium and phosphorus are considered as a major contributor to UP in dialysis patients [37]. The excessive retention of PTH and β2-MG may paly important role in pruritus, peripheral nerve changes, vascular calcification and renal osteodystrophy in patients with ESRD [38].…”

Cholecalciferol Supplementation Attenuates Bone Loss in Incident Kidney Transplant Recipients: A Prespecified Secondary Endpoint Analysis of a Randomized Controlled Trial

“…( 20 , 21 ) Consistently, most RCTs conducted among patients on dialysis failed to demonstrate a beneficial effect of vitamin D supplementation on PTH levels. ( 9 , 10 , 22 , 23 , 24 ) Meanwhile, Taniguchi and colleagues demonstrated that successful KTx causes regression of the parathyroid gland with diffuse hyperplasia and restores its expression of VDR. ( 12 ) Probable VDR restoration and high 25(OH)D levels, coupled with accelerated conversion of 25(OH)D to 1,25(OH) 2 D due to secondary hyperparathyroidism and healthy kidney transplanted, could contribute to PTH reduction by cholecalciferol supplementation in the current study.…”