Prevalence of 25-OH vitamin D deficiency in a population of hemodialysis patients and efficacy of an oral ergocalciferol supplementation regimen.

Abstract

BACKGROUND/AIMS:

Optimal dosing regimens for 25-OH vitamin D (VitD) deficiency are unknown in hemodialysis (HD) patients. Our aim was to evaluate the efficacy of prescribing ergocalciferol supplementation based on KDOQI guidelines for chronic kidney disease (CKD) stages III-IV in HD patients.

METHODS:

We conducted a retrospective study of 96 urban, predominately African-American HD patients at a single-center dialysis unit with VitD insufficiency or deficiency treated with ergocalciferol. Patients were classified as either compliant or non-compliant with supplementation as determined by review of pharmacy records. The primary outcome was VitD levels 6 months after initiation of treatment and secondary outcomes were VitD levels at 11 months, bone/mineral and anemia parameters.

RESULTS:

The population was predominately African-American (69%) and Hispanic (28%). There were 61 individuals in the compliant group and 35 individuals in the non-compliant group. The compliant group was older but otherwise similar in demographics and co-morbid conditions to the non-compliant group. After 6 months of treatment, the compliant group had a significant increase in VitD level (14.7 ± 6.0 to 28.7 ± 10.0 ng/ml, p < 0.0001) compared to the non-compliant group (14.7 ± 5.5 to 14.8 ± 7.1 ng/ml, p = 0.95). There were no differences in the incidence of hypercalcemia between the two groups. Except for a decrease in phosphorus in the compliant group (5.6 ± 1.6 to 4.9 ± 1.7 mg/dl, p = 0.004), there were no significant difference in bone/mineral or anemia parameters including dosing of darbepoetin.

CONCLUSION:

An ergocalciferol-prescribing strategy using the KDOQI guidelines for stage III-IV kidney disease in HD patients with VitD deficiency or insufficiency is inadequate to achieve repletion or maintenance of normal VitD levels.

• Authors: Anna Porter, Cheryl Gilmartin, Usasiri Srisakul, Jose Arruda, Sanjeev Akkina
• Journal: American journal of nephrology (Am J Nephrol) Vol. 37 Issue 6 Pg. 568-74 ( 2013) ISSN: 1421-9670 [Electronic] Switzerland
• PMID: 23735861 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2013 S. Karger AG, Basel.

Chemical References

• Ergocalciferols
• Vitamins
• Calcifediol

Topics

• Adult
• Aged
• Calcifediol (deficiency)
• Ergocalciferols (therapeutic use)
• Female
• Humans
• Kidney Failure, Chronic (complications, therapy)
• Male
• Medication Adherence
• Middle Aged
• Renal Dialysis
• Retrospective Studies
• Treatment Outcome
• Vitamin D Deficiency (complications, drug therapy)
• Vitamins (therapeutic use)