Journal Mobile Options
Table of Contents
Vol. 110, No. 1, 2008
Issue release date: September 2008
Section title: Original Paper
Nephron Clin Pract 2008;110:c58
(DOI:10.1159/000151534)

Evidence for Persistent Vitamin D 1-Alpha-Hydroxylation in Hemodialysis Patients: Evolution of Serum 1,25-Dihydroxycholecalciferol after 6 Months of 25-Hydroxycholecalciferol Treatment

Jean G. · Terrat J.C. · Vanel T. · Hurot J.M. · Lorriaux C. · Mayor B. · Chazot C.
Centre de Rein Artificiel, Tassin, France

Do you have an account?

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger (new!)
  • Unrestricted printing, no saving restrictions for personal use
  • Reduced rates with a PPV account
read more

Direct: USD 38.00
Account: USD 26.50

Select

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Automatic perpetual access to all articles of the subscribed year(s)
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/11/2008
Accepted: 4/6/2008
Published online: 8/25/2008

Number of Print Pages: 1
Number of Figures: 4
Number of Tables: 1

ISSN: (Print)
eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC

Abstract

Background: End-stage renal disease (ESRD) patients are thought to have impaired 1-α-hydroxylase capacity, but an extrarenal source of 1,25(OH)2D has been recognized. Objective: The aim of this study was to assess the evolution of serum 1,25(OH)2D in hemodialysis (HD) patients with vitamin D deficiency after 6 months of 25(OH)D3 supplementation, and to identify the factors associated with persistent 1,25(OH)2D production. Methods: HD patients in a HD center with vitamin D deficiency (i.e. 25(OH)D <75 nmol/l) who were not receiving any vitamin D derivatives or calcimimetics were studied. Patients who had previously undergone parathyroidectomy or nephrectomy or those with uncontrolled hypercalcemia or hyperphosphatemia were excluded from this study. The patients were administrated a dose of 10–30 µg/day of oral 25(OH)D3 based on the severity of their deficiency. The serum levels of 25(OH)D and 1,25(OH)2D evolution after 6 months were recorded. Responders were defined as patients with an increase in serum 1,25(OH)2D levels greater than the median value. Changes in mineral metabolism parameters were compared with those in the nonresponders. Results: Of the 253 patients, 225 (89%) were vitamin D-deficient, and 43 met the inclusion criteria. The patients were 72.6 ± 10 years old and had been on dialysis for 71 ± 70 months; 39% of the patients were female and 45% were diabetics. From baseline to 6 months of treatment, serum 25(OH)D levels increased from 27.8 ± 18 to 118 ± 34 nmol/l (p < 0.001) and serum 1,25(OH)2D levels increased from 7.7 ± 5 to 30.5 ± 15 pmol/l (p < 0.001) with a median increase of 20 pmol/l. The mean serum calcium level increased from 2.19 ± 0.1 to 2.25 ± 0.1 mmol/l (p = 0.009), the intact parathyroid hormone (iPTH) level decreased from 144 ± 108 to 108 ± 63 pg/ml (p = 0.05), and the bone alkaline phosphatase (BALP) level remained unchanged. The serum phosphate level increased slightly from 1.22 ± 0.3 to 1.34 ± 0.2 mmol/l (p = 0.04) with reduced hypophosphatemia. Compared with the responders (n = 24), most of the nonresponders (n = 19) were diabetic (63 vs. 29%, p = 0.02) and had a lesser increase of their 25(OH)D serum level. The serum level of FGF-23 was not significant. A positive correlation was observed between serum 1,25(OH)2D and serum 25(OH)D levels after 6 months of 25(OH)D3 treatment (p = 0.02). Conclusion: The Kidney Disease Outcomes Quality Improvement (KDOQI) guidelines do not recommend checking and treating vitamin D deficiency in chronic kidney disease (CKD) stage 5 patients due to the supposed lack of 1,25(OH)2D production. These data confirm persistent renal or extra-renal production of 1,25(OH)2D in HD patients after 6 months of 25(OH)D3 administration. Diabetes is the main factor associated with impaired 1,25(OH)2D production. 25(OH)D3 administration corrects vitamin D deficiency with few effects on mineral metabolism and stability of bone turnover markers.


  

Author Contacts

Guillaume Jean
Centre de Rein Artificiel, 42, avenue du 8 mai 1945
FR–69160 Tassin (France)
Tel. +33 47 232 3124, Fax +33 47 834 1673
E-Mail guillaume-jean-crat@wanadoo.fr, Gjean14357@aol.com

  

Article Information

Received: March 11, 2008
Accepted: June 4, 2008
Published online: August 25, 2008
Number of Print Pages : 8
Number of Figures : 4, Number of Tables : 1, Number of References : 36

  

Publication Details

Nephron Clinical Practice

Vol. 110, No. 1, Year 2008 (Cover Date: September 2008)

Journal Editor: El Nahas M. (Sheffield)
ISSN: 1660–2110 (Print), eISSN: 1660–2110 (Online)

For additional information: http://www.karger.com/NEC


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/11/2008
Accepted: 4/6/2008
Published online: 8/25/2008

Number of Print Pages: 1
Number of Figures: 4
Number of Tables: 1

ISSN: (Print)
eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.