Ergocalciferol Benefits CKD Patients
Ergocalciferol supplementation in CKD patients can safely raise levels of serum 25-hydroxyvitamin (OH) D levels and decrease serum intact parathyroid hormone (iPTH) levels, especially in patients with stage 4 renal disease.
National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines recommend that CKD patients who have decreased 25 (OH) D levels receive supplementation. Little published data are available on the effect of supplementation on 25 (OH) D serum levels and serum parathyroid hormone levels.
In a study, 85 patients with stages 3-5 CKD referred to the Kaiser Kidney Program received ergocalcif-erol in doses range from 800 IU a day to 50,000 IU a week and were followed for a period of 12 months. Investigators measured baseline serum iPTH levels and serum 25 (OH) D levels.
“We found in this case series that in all stages of CKD, there was a small but significant decline in the iPTH levels and a rather significant increase in 25-hydroxyvitamin D levels in all stages of CKD. There was no hypercalcemia,” said lead investigator Micah Thorp, DO, MPH, a nephrologist with Kaiser Permanente Northwest Center for Health Research in Portland, Ore.“What is key here is that this is a cheap, easily available vitamin that can help at all stages of CKD in lowering intact parathyroid hormone. It is probably not going to be the sole treatment for most patients because the drop is not large in iPTH levels, but it is important because it is effective and there are minimal complications and minimal costs.”
The patients had a mean age of 67.2 years, and 40% were female. At the beginning of the study 62% of the patients were on phosphate binders. Patients with 25 (OH) D levels of less than 16 ng/mL (40 nmol/L) were prescribed 50,000 IU of ergocalciferol twice weekly for eight weeks followed by 800 IU a day.
Patients with 25 (OH) D levels between 16 and 30 ng/mL (40 and 75 nmol/L) were prescribed 50,000 IU once a month for two months followed by 800 IU a day. Patients with 25 (OH) D levels of greater than 30 ng/mL (75 nmol/L) were prescribed 800 IU a day.The mean pretreatment serum 25 (OH) D level was 43.4 ng/mL. At 12 months, it was 105.3 ng/mL. Not one patient required cessation of vitamin D therapy during follow-up and no adverse outcomes were reported. The mean pretreatment serum iPTH level was 18.7 pg/mL; it declined to 15.8 pg/mL at the end of the study, a mean difference of 2.9 pg/mL. The mean difference was 3.6 pg/mL in patients with stage 4 CKD.