Abstract
We evaluated the improvement of intact parathyroid hormone (iPTH) levels and bone parameters by supplementing nutritional vitamin D (cholecalciferol) to combined calcimimetic (cinacalcet) and active vitamin D analog (calcitriol) among severe secondary hyperparathyroidism (SHPT) hemodialysis (HD) patients. A randomized, controlled open-label study was undertaken in 60 HD patients with serum iPTH > 1000 pg/mL or persistently high iPTH ≥ 600 pg/mL even after >3 months of calcitriol (3 µg/week). The study group received oral cholecalciferol (5000 IU/ day) and the control group received a placebo. All patients received fixed dose cinacalcet (30 mg/day, orally) and calcitriol. Calcitriol was reduced if iPTH ≤ 300 pg/mL and cinacalcet was withdrawn if serum iPTH was persistently low (iPTH ≤ 300 pg/mL) for 4 weeks after the reduction of calcitriol. A significantly lower iPTH level was noted from the 20th week in the study group compared to the placebo group, and the target iPTH ≤ 300 pg/mL was achieved at the 24th week in the study group. Most patients achieved serum 25-(OH)D3 ≥ 30 ng/mL in the study group. Nearly 40% of study patients gained >10% improvement in femoral neck (FN) bone mineral density (BMD). We conclude that cholecalciferol additively reduced serum iPTH levels, improved 25-(OH)D3 levels and improved FN BMD when used together with cinacalcet/calcitriol in severe SHPT HD patients.
Original language | English |
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Article number | 196 |
Journal | Nutrients |
Volume | 10 |
Issue number | 2 |
DOIs | |
Publication status | Published - Feb 10 2018 |
Keywords
- Calcitriol
- Cholecalciferol
- Cinacalcet
- Hemodialysis
- Secondary hyperparathyroidism
- Calcifediol/blood
- Calcitriol/blood
- Severity of Illness Index
- Femur Neck/drug effects
- Humans
- Hyperparathyroidism, Secondary/blood
- Middle Aged
- Cinacalcet/blood
- Male
- Cholecalciferol/blood
- Bone Density/drug effects
- Calcimimetic Agents/blood
- Renal Dialysis/adverse effects
- Female
- Aged
- Vitamins/blood
- Dietary Supplements
- Parathyroid Hormone/blood
ASJC Scopus subject areas
- Food Science
- Nutrition and Dietetics