Weekly (50,000 units) and monthly doses (50,000 units) of ergocalciferol treatment does not significantly impact markers of mineral metabolism (MM) in chronic hemodialysis (HD) patients, a study suggests.
Use of activated vitamin D (VDRA) to treat secondary hyperparathyroidism (SHPT) and MM is considered an important management tool in chronic HD patients.
However, replacement of 25-hydroxyvitamin D (25-D) has not traditionally been performed in HD patients and little is known about the effects of 25-D replacement. Investigators at Evanston Hospital, NorthShore University HealthSystem in Evanston, Ill., looked at the ability of ergocalciferol treatment to correct 25-D deficiencies in HD patients, and the effect on SHPT and markers of MM.
A total of 92 HD patients from a single center were screened for baseline 25-D. Those patients with levels of less than 30 ng/mL were prescribed 50,000 units of ergocalciferol weekly, and those patients with levels above 30 ng/mL were given 50,000 units monthly.
All patients were followed prospectively with baseline and quarterly laboratory results for six months. The researchers analyzed the effects of ergocalciferol on 25-D, intact parathyroid hormone (iPTH), serum alkaline phosphatase (AP), calcium (Ca), phosphorus (P), and total dosing of VDRA.
Among the 92 patients, 72 (78%) had 25-D levels below 30 ng/mL at baseline. During the six-month follow-up, the researchers found that 25-D levels significantly increased from an average of 23.5 to 29.2 ng/mL. The average iPTH level at baseline was 411.4 pg/mL and the level did not change significantly over the six months.
Furthermore, the researchers observed no significant changes in Ca, P, and AP. The investigators concluded that further evaluation of the long-term administration of ergocalciferol is needed and that it may be necessary to prescribe even higher doses of 25-D in this patient population.
“For this particular study, we were able to show there was a high prevalence of a vitamin D deficiency,” said investigator Neenoo Khosla, MD, Assistant Professor of Medicine at University Health Systems, University of Chicago.
“We found that giving ergocalciferol was safe and effective at increasing vitamin D levels. However, in this short follow-up of nine months, we were not able to see any clinically significant difference in calcium, phosphorus, and parathyroid hormone.”