The effect of combined calcium and vitamin D3 supplementation on serum intact parathyroid hormone in moderate CKD

Am J Kidney Dis. 2009 Mar;53(3):408-16. doi: 10.1053/j.ajkd.2008.09.020. Epub 2009 Jan 29.


Background: Studies addressing the effects of vitamin D(3) supplementation on secondary hyperparathyroidism in patients with moderate chronic kidney disease are scarce.

Study design: Post hoc analysis of the randomized clinical trial Vitamin D, Calcium, Lyon Study II (DECALYOS II) to assess effects according to baseline estimated glomerular filtration rate (eGFR).

Setting & participants: Multicenter, randomized, double-blinded, placebo-controlled study of 639 elderly women randomly assigned to calcium-vitamin D(3) fixed combination; calcium plus vitamin D(3) separate combination, or placebo.

Interventions: Placebo or calcium (1,200 mg) and vitamin D(3) (800 IU) in fixed or separate combination.

Outcomes & measurements: Proportion of participants with a mean decrease in intact parathyroid hormone (iPTH) level of 30% or greater. eGFR was calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation and categorized as 60 or greater, 45 to 59, and less than 45 mL/min/1.73 m(2).

Results: 610 participants had an eGFR at baseline: 288 (47.2%), 222 (36.4%), and 100 (16.4%) were in each decreasing eGFR category. Across decreasing eGFR groups, 88%, 86%, and 89% had 25-hydroxyvitamin D (25[OH]D) levels less than 15 ng/mL at baseline. On treatment, similar improvements in the proportion of participants achieving 25(OH)D levels greater than 30 ng/mL at 6 months were seen in all kidney function groups (43%, 49%, and 41%, respectively). Active regimens versus placebo increased mean 25(OH)D levels from baseline in all eGFR groups at all times (P < 0.001 for all). The proportion with a 30% or greater decrease in iPTH level at 6 months was 50% in all eGFR groups on treatment versus 6% to 9% for placebo (P < 0.001 for all). The effects of the intervention on iPTH levels did not differ according to baseline eGFR (interaction P > 0.1 for all times).

Limitations: This study included only elderly white women.

Conclusion: Vitamin D(3) was effective in increasing 25(OH)D and decreasing iPTH levels in patients with moderate chronic kidney disease.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged, 80 and over
  • Calcium, Dietary / administration & dosage*
  • Cholecalciferol / administration & dosage*
  • Chronic Disease
  • Dietary Supplements*
  • Double-Blind Method
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / blood*
  • Hyperparathyroidism, Secondary / complications
  • Hyperparathyroidism, Secondary / diet therapy*
  • Kidney Diseases / blood*
  • Kidney Diseases / complications*
  • Parathyroid Hormone / blood*
  • Severity of Illness Index
  • Vitamins / administration & dosage*


  • Calcium, Dietary
  • Parathyroid Hormone
  • Vitamins
  • Cholecalciferol