EFFICACY OF DOUBLE DOSE VERSUS STANDARD DOSE ERGOCALCIFEROL ON VITAMIN D STATUS AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE
DOI:
https://doi.org/10.55374/jseamed.v4i2.70Keywords:
Hyperparathyroidism, Chronic kidney disease, 25-hydroxyvitamin D deficiency, ErgocalciferolAbstract
Background: Patients with chronic kidney disease (CKD) have an exceptionally high rate of 25-hydroxyvitamin D (25-OHD) deficiency. Modest supplementation with ergocalciferol to raise serum 25-OH-D levels might improve bone and mineral disorders in CKD. Limited evidence is available regarding dosage of ergocalciferol supplement in CKD populations.
Objectives: The study aimed to examine the effectiveness of double-dose ergocalciferol on serum 25-OHD, serum intact parathyroid hormone (PTH) levels and mineral and safety profiles compared with standard-dose ergocalciferol among CKD subjects.
Methods: The study employed a 12-week open labeled, randomized, controlled design among patients with CKD at stages III-IV and serum 25-OHD <30 ng/mL. Patients were randomized in 2 groups: standard dose treated with ergocalciferol as recommended by K/DOQI guidelines or double dose of ergocalciferol from recommendations. Serum testing including 25-OHD, intact PTH, phosphate and calcium was performed at baseline and week 12.
Results: Sixty-three patients were included [standard-dose group (N=30) and double-dose group (N=34)]. At the end of the 12 weeks, 20 (58.8%) patients in the double dose ergocalciferol group achieved sufficiency compared with 6 (20%) patients in the standard dose ergocalciferol group (p<0.05). A significant increase in serum 25-OHD levels (13.6±9.9 vs. 8.5±6.8 ng/mL, p=0.030) and decrease in serum PTH level group (-16.8±26.4 vs. -0.3±26.8 pg/mL, p=0.030) was found in the double-dose group compared with the standard-dose group. No adverse effect was associated with the treatment.
Conclusion: The study demonstrated that high dose oral ergocalciferol had higher efficacy to increase serum 25-OHD and decrease serum PTH levels among patients with CKD than standard-dose ergocalciferol after 12 weeks of treatment.
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References
Yadav AK, Kumar V, Kumar V, Banerjee D, Gupta KL, Jha V. The Effect of Vitamin D Supplementation on Bone Metabolic Markers in Chronic Kidney Disease. J Bone Miner Res 2018; 33: 404-9. DOI: https://doi.org/10.1002/jbmr.3314
Gonzalez EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004; 24: 503-10. DOI: https://doi.org/10.1159/000081023
Jayedi A, Soltani S, Shab-Bidar S. Vitamin D status and all-cause mortality in patients with chronic kidney disease: A systematic review and dose-response meta-analysis. J Clin Endocrinol Metab 2017; 102: 2136-45. DOI: https://doi.org/10.1210/jc.2017-00105
Xie S, Huang L, Cao W, et al. Association between serum 25-hydroxyvitamin D and diabetic kidney disease in Chinese patients with type 2 diabetes. PLoS One 2019; 14: e0214728. DOI: https://doi.org/10.1371/journal.pone.0214728
Pilz S, Iodice S, Zittermann A, Grant WB, Gandini S. Vitamin D status and mortality risk in CKD: a meta-analysis of prospective studies. Am J Kidney Dis 2011; 58: 374-82. DOI: https://doi.org/10.1053/j.ajkd.2011.03.020
Ravani P, Malberti F, Tripepi G, et al. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int 2009; 75: 88-95. DOI: https://doi.org/10.1038/ki.2008.501
Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007; 71: 31-8. DOI: https://doi.org/10.1038/sj.ki.5002009
Alvarez JA, Law J, Coakley KE, et al. Highdose cholecalciferol reduces parathyroid hormone in patients with early chronic kidney disease: a pilot, randomized, doubleblind, placebo-controlled trial. Am J Clin Nutr 2012; 96: 672-9. DOI: https://doi.org/10.3945/ajcn.112.040642
Dogan E, Erkoc R, Sayarlioglu H, Soyoral Y, Dulger H. Effect of depot oral cholecalciferol treatment on secondary hyperparathyroidism in stage 3 and stage 4 chronic kidney diseases patients. Ren Fail 2008;30:407-10. DOI: https://doi.org/10.1080/08860220801964210
Alvarez J, Wasse H, Tangpricha V. Vitamin D supplementation in pre-dialysis chronic kidney disease: A systematic review. Dermatoendocrinol 2012; 4: 118-27. DOI: https://doi.org/10.4161/derm.20014
Thimachai P, Supasyndh O, Chaiprasert A, Satirapoj B. Efficacy of High vs. Conventional Ergocalciferol Dose for Increasing 25- Hydroxyvitamin D and Suppressing Parathyroid Hormone Levels in Stage III-IV CKD with Vitamin D Deficiency/Insufficiency: A Randomized Controlled Trial. J Med Assoc Thai 2015; 98: 643-8.
Alfieri C, Ruzhytska O, Vettoretti S, Caldiroli L, Cozzolino M, Messa P. Native Hypovitaminosis D in CKD Patients: From Experimental Evidence to Clinical Practice. Nutrients 2019; 11: 1918. DOI: https://doi.org/10.3390/nu11081918
Hewison M. Vitamin D and immune function: autocrine, paracrine or endocrine? Scand J Clin Lab Invest Suppl 2012; 243: 92-102.
Goldsmith DJ. Pro: Should we correct vitamin D deficiency/insufficiency in chronic kidney disease patients with inactive forms of vitamin D or just treat them with active vitamin D forms? Nephrol Dial Transplant 2016; 31: 698-705. DOI: https://doi.org/10.1093/ndt/gfw082
Lee YH, Kim JE, Roh YH, et al. The combination of vitamin D deficiency and mild to moderate chronic kidney disease is associated with low bone mineral density and deteriorated femoral microarchitecture: results from the KNHANES 2008-2011. J Clin Endocrinol Metab 2014; 99: 3879-88. DOI: https://doi.org/10.1210/jc.2013-3764
Zisman AL, Hristova M, Ho LT, Sprague SM. Impact of ergocalciferol treatment of vitamin D deficiency on serum parathyroid hormone concentrations in chronic kidney disease. Am J Nephrol 2007; 27: 36-43. DOI: https://doi.org/10.1159/000098561
Bhan I, Dobens D, Tamez H, et al. Nutritional vitamin D supplementation in dialysis: a randomized trial. Clin J Am Soc Nephrol 2015; 10: 611-9. DOI: https://doi.org/10.2215/CJN.06910714
Kovesdy CP, Lu JL, Malakauskas SM, Andress DL, Kalantar-Zadeh K, Ahmadzadeh S. Paricalcitol versus ergocalciferol for secondary hyperparathyroidism in CKD stages 3 and 4: a randomized controlled trial. Am J Kidney Dis 2012; 59: 58-66. DOI: https://doi.org/10.1053/j.ajkd.2011.06.027
Al-Aly Z, Qazi RA, Gonzalez EA, Zeringue A, Martin KJ. Changes in serum 25-hydroxyvitamin D and plasma intact PTH levels following treatment with ergocalciferol in patients with CKD. Am J Kidney Dis 2007; 50 :59-68. DOI: https://doi.org/10.1053/j.ajkd.2007.04.010
Oksa A, Spustova V, Krivosikova Z, et al. Effects of long-term cholecalciferol supplementation on mineral metabolism and calciotropic hormones in chronic kidney disease. Kidney Blood Press Res 2008; 31: 322-9. DOI: https://doi.org/10.1159/000157177
Kandula P, Dobre M, Schold JD, Schreiber MJ, Jr., Mehrotra R, Navaneethan SD. Vitamin D supplementation in chronic kidney disease: a systematic review and meta-analysis of observational studies and randomized controlled trials. Clin J Am Soc Nephrol 2011; 6: 50-62. DOI: https://doi.org/10.2215/CJN.03940510
Arcidiacono MV, Yang J, Fernandez E, Dusso A. The induction of C/EBPbeta contributes to vitamin D inhibition of ADAM17 expression and parathyroid hyperplasia in kidney disease. Nephrol Dial Transplant 2015; 30: 423-33. DOI: https://doi.org/10.1093/ndt/gfu311
Satirapoj B, Limwannata P, Chaiprasert A, Supasyndh O, Choovichian P. Vitamin D insufficiency and deficiency with stages of chronic kidney disease in an Asian population. BMC Nephrol 2013; 14: 206. DOI: https://doi.org/10.1186/1471-2369-14-206
Levin GP, Robinson-Cohen C, de Boer IH, et al. Genetic variants and associations of 25-hydroxyvitamin D concentrations with major clinical outcomes. JAMA 2012; 308: 1898-905. DOI: https://doi.org/10.1001/jama.2012.17304
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