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Hemodialysis Patients May Benefit from Cholecalciferol Treatment Targeting High Level of 25(OH)D

Abstract

(1) : Vitamin D is implicated in the pathogenesis of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) in hemodialysis (HD) patients, including the development of secondary hyperparathyroidism (SHP). While cholecalciferol supplementation is recommended for vitamin D deficiency correction, its impact on CKD-MBD remains inconsistent. The aim of this observational prospective study was to assess the effect of cholecalciferol in achieving high-normal serum 25-hydroxycholecalciferol (25(OH)D > 75 ng/mL) levels and its impact on CKD-MBD biochemical markers, including 1,25-dihydroxycholecalciferol (1,25(OH)D) and parathormone (PTH) in HD patients. The study also evaluated the maintenance dosage required to sustain 25(OH)D levels within the 50-75 ng/mL range. (2) : A total of 22 HD patients with baseline 25(OH)D levels 30-50 ng/mL received cholecalciferol (70,000 IU/week) to achieve the target serum 25(OH)D > 75 ng/mL. Baseline data on calcium, phosphate, 1-84 PTH, 25(OH)D, and 1,25(OH)D serum levels were compared with the data when 25(OH)D > 75 ng/mL was targeted or when the highest 25(OH)D levels were noted. (3) : Cholecalciferol significantly improved vitamin D status in HD patients, with 73% reaching the target 25(OH)D level >75 ng/mL in a median time of 7.5 weeks, with a median total dose of 525,000 IU. This was associated with a significant rise in 1,25(OH)D, decrease in 1-84 PTH, and no significant effect on calcium and phosphate levels. The median maintenance dose of cholecalciferol was established at 30,000 IU/week. (4) : The findings support the use of cholecalciferol targeting high normal 25(OH)D levels to improve biochemical markers of CKD-MBD in HD patients.

References
1.
Mieczkowski M, Zebrowski P, Wojtaszek E, Stompor T, Przedlacki J, Bartoszewicz Z . Long-term cholecalciferol administration in hemodialysis patients: a single-center randomized pilot study. Med Sci Monit. 2014; 20:2228-34. PMC: 4238795. DOI: 10.12659/MSM.892315. View

2.
Jean G, Terrat J, Vanel T, Hurot J, Lorriaux C, Mayor B . Evidence for persistent vitamin D 1-alpha-hydroxylation in hemodialysis patients: evolution of serum 1,25-dihydroxycholecalciferol after 6 months of 25-hydroxycholecalciferol treatment. Nephron Clin Pract. 2008; 110(1):c58-65. DOI: 10.1159/000151534. View

3.
Wasse H, Huang R, Long Q, Singapuri S, Raggi P, Tangpricha V . Efficacy and safety of a short course of very-high-dose cholecalciferol in hemodialysis. Am J Clin Nutr. 2012; 95(2):522-8. PMC: 3260077. DOI: 10.3945/ajcn.111.025502. View

4.
Pludowski P, Kos-Kudla B, Walczak M, Fal A, Zozulinska-Ziolkiewicz D, Sieroszewski P . Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland. Nutrients. 2023; 15(3). PMC: 9920487. DOI: 10.3390/nu15030695. View

5.
Brandenburg V, Ketteler M . Vitamin D and Secondary Hyperparathyroidism in Chronic Kidney Disease: A Critical Appraisal of the Past, Present, and the Future. Nutrients. 2022; 14(15). PMC: 9330693. DOI: 10.3390/nu14153009. View