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5700 IU of vitamin D helped half with chronic kidney disease if not having dialysis – July 2012

Randomized controlled trial of cholecalciferol supplementation in chronic kidney disease patients with hypovitaminosis D

Nephrology Dialysis Transplantation (2012), First published online: July 20, 2012
Peter Marckmann 1,2?, Hanne Agerskov 1, Sasikala Thineshkumar 1,2, Else-Marie Bladbjerg 3, Johannes J. Sidelmann 3, Jørgen Jespersen 3, Mads Nybo 4, Lars M. Rasmussen 4, Ditte Hansen 5 and Alexandra Scholze 1,2
1 Clinical Research Unit, Department of Nephrology, Odense University Hospital, Odense, Denmark
2 Clinical Institute, University of Southern Denmark, Odense, Denmark
3 Unit for Thrombosis Research, Institute of Public Health, University of Southern Denmark and Department of Clinical Biochemistry, Hospital of Southwest Denmark, Esbjerg, Denmark
4 Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
5 Department of Internal Medicine, Roskilde Hospital, Roskilde, Denmark
Correspondence to: Peter Marckmann; E-mail: peter.marckmann at dadlnet.dk
Received December 2, 2011. Accepted March 19, 2012.

Background Hypovitaminosis D is common in chronic kidney disease (CKD).
Effects of 25-hydroxyvitamin D replenishment in CKD are not well described.

Methods An 8-week randomized, placebo-controlled, double-blind parallel intervention study was conducted in haemodialysis (HD) and non-HD CKD patients. Treatment consisted of 40 000 IU of cholecalciferol orally per week. Plasma 25-hydroxyvitamin D (25-OHD), plasma 1,25-dihydroxyvitamin D (1,25-diOHD), plasma parathyroid hormone (PTH), serum phosphate, ionized serum calcium and serum fibroblast growth factor 23 (FGF-23) were analysed. We also investigated biomarkers related to cardiovascular disease (plasma D-dimer, plasma fibrinogen, plasma von Willebrand factor antigen and activity, plasma interleukin 6, plasma C-reactive protein, blood pressure, aortic augmentation index, aortic pulse wave velocity and 24-h urinary protein loss). Objective and subjective health variables were assessed (muscle function tests, visual analogue scores and Health Assessment Questionnaire).

Results Fifty-two CKD patients with 25-OHD <50 nmol/L at screening were included. Cholecalciferol supplementation led to a significant increase to a median of 155 nmol/L 25-OHD (interquartile range 137–173 nmol/L) in treated patients (n = 25, P < 0.001).

In non-HD patients, we saw a significant increase in 1,25-diOHD (n = 13, P < 0.01) and a lowering of PTH (n = 13, P < 0.001).

This was not observed in HD patients. Cholecalciferol supplementation caused a significant increase in serum calcium and FGF-23.

Conclusions 25-OHD replenishment was effectively obtained with the employed cholecalciferol dosing. In non-HD patients, it had favourable effects on 1,25-diOHD and PTH. Vitamin D-supplemented patients must be monitored for hypercalcaemia.

The present study could not identify significant pleiotropic effects of 25-OHD replenishment.

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Summary by author for VitaminDWiki

  • 40,000 IU cholecalciferol weekly for just 8 weeks to 25 patients with Chronic Kidney Disease and hypovitaminosis D (vitamin D levels below 20 nanograms/mL) , placebo to 24 matched controls
  • Active treatment corrected hypovitaminosis in all patients with final average vitamin D levels of 62 nanograms/mL versus 9 nanograms/mL in the placebo group.
    Note: Vitamin D levels would probably have been much higher if the trial had lasted longer
    Vitamin D half-life is 4-8 weeks.
  • Beneficial effects on bone metabolism were seen in the subgroup of patients who were NOT undergoing dialysis, but not in patients undergoing dialysis

See also VitaminDWiki