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

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

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1
Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti - Italy.

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.

PMID:
20175051
[Indexed for MEDLINE]
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