High-Dose Cholecalciferol Supplementation for Vitamin D Deficiency in Haemodialysis Patients

Jakopin, Eva; Balon, Breda Pečovnik; Ekart, Robert; Gorenjak, Maksimilijan

doi:10.1177/147323001103900345

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…This is consistent with previous studies which have shown that using fixed doses of vitamin D in patients with lower baseline levels results in lower steady state concentrations under supplementation and requires higher doses of the supplement to further increase the patient serum 25(OH)D levels [8, 11, 14, 31, 33, 38, 48, 70]. Holick and Chen emphasized that the baseline 25(OH)D concentration is an important factor in the individual response to vitamin D supplementation [2].…”

Section: Discussionsupporting

confidence: 92%

Oral Postdialysis Cholecalciferol Supplementation in Patients on Maintenance Hemodialysis: A Dose-Response Approach

Descombes

Fellay²,

Hemett

et al. 2014

International Journal of Nephrology

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The aim of the present study was to evaluate the dose of postdialysis cholecalciferol needed to maintain the 25-hydroxyvitamin D [25(OH)D] levels in the optimal range of 75–150 nmol/L. Twenty-six patients who had low baseline 25(OH)D levels (mean 27.5 ± 14.9 nmol/L) were studied. The 25(OH)D levels were measured every 2 months for one year. During the first two months, all the patients received 2000 IU of cholecalciferol after each hemodialysis (=6000 IU/wk). Thereafter, the dose was individualized and adapted every 2 months by administering 1 to 6 cholecalciferol tablets (2000 IU each) per week (total weekly dose = 2000–12000 IU/wk). During cholecalciferol supplementation, the 25(OH)D concentrations rapidly increased from baseline to 140.1 ± 28.3 nmol/L at month 6 and 95.6 ± 20.9 nmol/L at month 12. At month twelve, 86% of the patients had 25(OH)D levels within the target range with a mean dose of 5917 ± 4106 IU/wk of cholecalciferol; however, the amount needed to maintain these levels varied widely from 0 (n = 2) to 12000 IU/wk (n = 5). In conclusion, postdialysis cholecalciferol prescription is quite effective in correcting vitamin D deficiency/insufficiency, but the amount of cholecalciferol needed to maintain the 25(OH)D levels within the optimal range over the long-term varies widely among patients and must be individualized.

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Section: Discussionsupporting

confidence: 92%

Oral Postdialysis Cholecalciferol Supplementation in Patients on Maintenance Hemodialysis: A Dose-Response Approach

Descombes

Fellay²,

Hemett

et al. 2014

International Journal of Nephrology

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“…Table 2 summarizes the studies assessing changes in serum 25OHD and PTH with vitamin D supplementation. [76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92] Supplementation with calcidiol in CKD stage 5D improved bone mineralization but had a limited effect on reducing serum PTH similar to non-CKD patients. 93,94 Several studies have also looked at the correlation between serum vitamin D level and BMD in CKD and non-CKD populations.…”

Section: Trabecular Bone Scorementioning

confidence: 99%

Fractures in patients with CKD—diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation

Pimentel

Ureña-Torres

Zillikens

et al. 2017

Kidney International

176

122

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Mineral and bone disease is omnipresent in patients with chronic kidney disease (CKD) and leads to a diverse range of clinical manifestations, including bone pain and fractures. The accumulation of traditional clinical risk factors, in addition to those related to CKD, enhances the risk of comorbidity and mortality. Despite significant advances in understanding bone disease in CKD, most clinical and biochemical targets used in clinical practice remain controversial, resulting in an undermanagement of bone fragility. Vitamin D supplementation is widely used, but only a few studies have shown beneficial effects and a reduced risk of fracture and mortality. The achievement of serum levels of 25-hydroxyvitamin D is recommended for CKD patients to reduce a high parathyroid hormone level, which is associated with skeletal fractures. Optimal control of parathyroid hormone also improves bone mineralization and lowers circulating bone biomarkers such as alkaline phosphatase and cross-linked collagen type I peptide. The potential value of more recent biomarkers such as sclerostin and fibroblast growth factor 23, as surrogates for bone fragility, is an encouraging new direction in clinical research but is far from being firmly established. This article reviews the literature related to the pathophysiological role of various mineral and biochemical factors involved in renal osteodystrophy. To better understand bone fragility in CKD, new information related to the impact of disturbances of mineral metabolism on bone strength is urgently needed. The combined expertise of clinicians from various medical disciplines appears crucial for the most successful prevention of fractures in these patients.Kidney International (2017) 92, 1343-1355; http://dx

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“…However, despite numerous publications on the metabolism of vitamin D, available data are still insufficient to permit formulation of clear guidelines for the monitoring of vitamin D supply and supplementing its deficits in patients undergoing hemodialysis due to end-stage renal disease [ 11 ]. Until recently, the reports on vitamin D supplementation in this patient population were limited to single-armed, unblinded, uncontrolled, or historical-control studies [ 12 – 21 ]; the results of the first randomized studies became available only in the last 2 years [ 22 – 25 ]. The studies demonstrated the efficacy of cholecalciferol supplementation; however, 3 of these studies had relatively short observation periods of 6 to 15 weeks; moreover, some of the study patients in all studies were concurrently treated with medications affecting vitamin D metabolism.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Cholecalciferol Administration in Hemodialysis Patients: A Single-Center Randomized Pilot Study

et al. 2014

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BackgroundData 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.Material/MethodsNineteen 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.ResultsWe 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.ConclusionsOral 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.

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High-Dose Cholecalciferol Supplementation for Vitamin D Deficiency in Haemodialysis Patients

Cited by 13 publications

References 24 publications

Oral Postdialysis Cholecalciferol Supplementation in Patients on Maintenance Hemodialysis: A Dose-Response Approach

Oral Postdialysis Cholecalciferol Supplementation in Patients on Maintenance Hemodialysis: A Dose-Response Approach

Fractures in patients with CKD—diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation

Long-Term Cholecalciferol Administration in Hemodialysis Patients: A Single-Center Randomized Pilot Study

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