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. 2010 May;5(5):905-11.
doi: 10.2215/CJN.06510909. Epub 2010 Mar 4.

Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters

Patrícia João Matias  1 , Cristina Jorge, Carina Ferreira, Marília Borges, Inês Aires, Tiago Amaral, Célia Gil, José Cortez, Aníbal Ferreira
Affiliations

Cholecalciferol supplementation in hemodialysis patients: effects on mineral metabolism, inflammation, and cardiac dimension parameters

Patrícia João Matias et al. Clin J Am Soc Nephrol. 2010 May.

Abstract

Background and objectives: Vitamin D deficiency is highly prevalent in chronic kidney disease. The aim of this study was to evaluate the effects of oral cholecalciferol supplementation on mineral metabolism, inflammation, and cardiac dimension parameters in long-term hemodialysis (HD) patients.

Design, setting, participants, & measurements: This 1-year prospective study included 158 HD patients. Serum levels of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D], intact parathyroid hormone, and plasma brain natriuretic peptide as well as circulating bone metabolism and inflammation parameters were measured before and after supplementation. Baseline 25(OH)D and 1,25(OH)(2)D levels were measured twice (end of winter and of summer, respectively). Therapy with paricalcitol, sevelamer, and darbepoietin was evaluated.

Results: There was an increase in serum 25(OH)D and 1,25(OH)(2)D levels after supplementation. Conversely, serum calcium, phosphorus, and intact parathyroid hormone were decreased. There was a reduction in the dosage and in the number of patients who were treated with paricalcitol and sevelamer. Darbepoietin use was also reduced, with no modification of hemoglobin values. Serum albumin increased and C-reactive protein decreased during the study. Brain natriuretic peptide levels and left ventricular mass index were significantly reduced at the end of the supplementation.

Conclusions: Oral cholecalciferol supplementation in HD patients seems to be an easy and cost-effective therapeutic measure. It allows reduction of vitamin D deficiency, better control of mineral metabolism with less use of active vitamin D, attenuation of inflammation, reduced dosing of erythropoiesis-stimulating agents, and possibly improvement of cardiac dysfunction.

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Figures

Figure 1.
Figure 1.
25(OH)D and 1,25(OH)2D serum values after winter, after summer, and after cholecalciferol supplementation.
Figure 2.
Figure 2.
Serum 25(OH)D distribution before and after supplementation.
Figure 3.
Figure 3.
25(OH)D and 1,25(OH)2D serum levels before and after supplementation in patients without and with paricalcitol therapy.
Figure 4.
Figure 4.
Correlations between the percentage of change in 25(OH)D and the percentage of change in BNP and LVMI with cholecalciferol supplementation.
See this image and copyright information in PMC

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