Vitamin D treatment in hemodialysis patients with low serum levels of parathyroid hormone: which is the best choice?

J Nephrol. Mar-Apr 2010;23(2):210-5.

Abstract

Background: This short-term prospective study aimed to assess the effects of treatment with calcidiol (25-hydroxycholecalciferol) or calcitriol in the subset of hemodialysis patients characterized by stable low serum levels of parathyroid hormone (PTH) or affected by hypoparathyroidism after total parathyroidectomy (PTx).

Methods: Two groups were created according to baseline serum levels of 25-hydroxyvitamin D (25(OH)D): group A (12 patients): <15 ng/mL; group B (12 patients): >15 ng/mL. They underwent a 6-month treatment with oral calcidiol (group A) or oral calcitriol (group B).

Results: Group A showed a statistically significant increase in the serum levels of calcium corrected for serum albumin (cCa), phosphorus (P), total alkaline phosphatases (ALP), PTH and 25(OH)D. Group B showed a statistically significant increase in serum levels of cCa and P. A statistically significant decrease in serum levels of ALP and 25(OH)D was observed. Baseline serum 25(OH)D levels were 12.6 + 3.8 ng/mL in group A and 23.0 + 5.0 ng/mL in group B (p<0.0001). After 6 months, they increased to 38.3 + 21.0 ng/mL in group A (p<0.01) and decreased to 16.9 + 5.8 ng/mL in group B (p<0.01).

Conclusions: Treatment with oral calcitriol was associated with a decrease in the serum levels of ALP and 25(OH)D; treatment with oral calcidiol was associated with more physiological serum levels of 25(OH)D and with an increase in the serum levels of ALP and PTH: whether the statistically significant differences in the biochemical parameters achieved with the 2 treatments have a clinical relevance, remains a matter of debate.

Publication types

  • Clinical Trial

MeSH terms

  • Administration, Oral
  • Aged
  • Alkaline Phosphatase / blood
  • Biomarkers / blood
  • Calcifediol / administration & dosage
  • Calcifediol / therapeutic use*
  • Calcitriol / administration & dosage
  • Calcitriol / therapeutic use*
  • Calcium / blood
  • Down-Regulation
  • Female
  • Humans
  • Hypoparathyroidism / blood
  • Hypoparathyroidism / etiology
  • Hypoparathyroidism / therapy*
  • Kidney Diseases / blood
  • Kidney Diseases / complications
  • Kidney Diseases / therapy*
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood*
  • Patient Selection*
  • Phosphorus / blood
  • Prospective Studies
  • Renal Dialysis*
  • Time Factors
  • Treatment Outcome
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamins / administration & dosage
  • Vitamins / therapeutic use*

Substances

  • Biomarkers
  • PTH protein, human
  • Parathyroid Hormone
  • Vitamins
  • Vitamin D
  • Phosphorus
  • 25-hydroxyvitamin D
  • Alkaline Phosphatase
  • Calcitriol
  • Calcifediol
  • Calcium