Cholecalciferol supplementation increases serum 25(OH)D3 levels in hemodialysis subjects with initial values in sub-optimal range
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The fact that vitamin D deficiency is common in the chronic kidney disease (CKD) population is widely known. The majority of hemodialysis (HD) subjects undergoing maintenance dialysis have been found to have vitamin D levels in the suboptimal range. Vitamin D deficiency is one of many abnormalities that predispose the HD patient to bone disease and increased risk of fractures. Methods: Subjects in the study were 87 HD subjects with a mean age of 59.4±13.6 years. Baseline and post vitamin D supplementation serum 25(OH)D3, bAP, intact parathyroid hormone (iPTH), and other bone related laboratory test results were obtained by chart review. In January 2008, 68 subjects with suboptimal serum vitamin D levels were provided with one bottle of over the counter (OTC) 1000 IU cholecalciferol capsules and were instructed to take one capsule per day and post- supplementation were taken after 20 weeks of treatment. Results: The mean ± standard deviation (SD) serum 25(OH)D3 baseline level of subjects was 16.0 ng/mL (normal range 16.0-74.0 ng/mL) and 44% of subjects had values < 16.0 ng/mL indicating suboptimal vitamin D status. The mean ± SD serum 25(OH)D3 level of complaint subjects who took over 40% of their vitamin D tablets (n=53) post treatment was 50.9 ± 14.8 ng/mL a value considered in normal range. The 25(OH)D3 mean concentration for non-compliant subjects (n=18) was 22.2 ng/mL from a baseline value of 15.9 ng/mL pre treatment. The serum bAP value was < 20 µg/L in 46.7% of subjects and > 50 µg/L (indicating high bone turnover) in 12.0% of subjects. Subjects with a mean bAP > 50 µg/L had significantly higher levels serum iPTH levels a stimulator of bone turnover, compared to the groups with normal and low bAP values (ANOVA, p<0.05) but group serum 25(OH)D3, calcium, and phosphorus means were not significantly different. Serum 25(OH)D3 levels were not significantly correlated to bAP (r = -0.036, p=0.741) or to iPTH (r =0.013, p=0.906). Conclusion: Our study demonstrates that daily supplementation of 1000 IU cholecalciferol for a period of 20 weeks can effectively increase vitamin D levels to normal range (>30 ng/mL) in hemodialysis subjects with vitamin D deficiency and/or vitamin D insufficiency. Serum 25(OH)D3 levels in HD subjects are not correlated to serum bAP or iPTH.