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Treatment of vitamin D deficiency in CKD patients with ergocalciferol: are current K/DOQI treatment guidelines adequate?
Clin Nephrol 2010; 73(4):276-85CN

Abstract

BACKGROUND

Vitamin D deficiency/insufficiency (VDDI) is common in CKD patients and may be associated with abnormal mineral metabolism. It is not clear whether the K/DOQI recommended doses of ergocalciferol are adequate for correction of VDDI and hyperparathyroidism.

METHODS

Retrospective study of 88 patients with CKD Stages 1 - 5 and baseline 25-hydroxyvitamin D level < 30 ng/ml (< 75 nmol/l). Patients treated with ergocalciferol as recommended by K/DOQI guidelines. Only 53 patients had elevated baseline PTH level for the CKD stage. Patients were excluded if they received vitamin D preparations other than ergocalciferol or phosphate binders. 25-hydroxyvitamin D level, intact PTH level (iPTH), and other parameters of mineral metabolism were measured at baseline and after completion of ergocalciferol course.

RESULTS

88 patients with CKD were treated with ergocalciferol. Mean age 56.8 +/- 9.5 years and 41% were males. The mean (+/- SD) GFR was 28.3 +/- 16.6 ml/min. At the end of the 6-month period of ergocalciferol treatment, the mean 25-hydroxyvitamin D level increased from 15.1 +/- 5.8 to 23.3 +/- 11.8 ng/ml (37.75 +/- 14.5 to 58.25 +/- 29.5 nmol/l) (p < 0.001). Treatment led to > or = 5 ng/ml (12.5 nmol/l) increases in 25-hydroxyvitamin D level in 54% of treated patients, and only 25% achieved levels > or = 30 ng/ml (75 nmol/l). Mean iPTH level decreased from 157.9 +/- 125.9 to 150.7 +/- 127.5 pg/ml (p = 0.5). Only 26% of patients had > or = 30% decrease in their iPTH level after treatment with ergocalciferol.

CONCLUSIONS

Current K/DOQI guidelines are inadequate for correcting VDDI or secondary hyperparathyroidism in CKD patients. Future studies should examine the effects of higher or more frequent dosing of ergocalciferol on these clinical endpoints.

Authors+Show Affiliations

Nephrology Division, Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. qunibi@uthscsa.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20353735

Citation

Qunibi, W Y., et al. "Treatment of Vitamin D Deficiency in CKD Patients With Ergocalciferol: Are Current K/DOQI Treatment Guidelines Adequate?" Clinical Nephrology, vol. 73, no. 4, 2010, pp. 276-85.
Qunibi WY, Abdellatif A, Sankar S, et al. Treatment of vitamin D deficiency in CKD patients with ergocalciferol: are current K/DOQI treatment guidelines adequate? Clin Nephrol. 2010;73(4):276-85.
Qunibi, W. Y., Abdellatif, A., Sankar, S., Hamdan, Z., Lin, F. Y., Ingle, J., ... Kasinath, B. (2010). Treatment of vitamin D deficiency in CKD patients with ergocalciferol: are current K/DOQI treatment guidelines adequate? Clinical Nephrology, 73(4), pp. 276-85.
Qunibi WY, et al. Treatment of Vitamin D Deficiency in CKD Patients With Ergocalciferol: Are Current K/DOQI Treatment Guidelines Adequate. Clin Nephrol. 2010;73(4):276-85. PubMed PMID: 20353735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of vitamin D deficiency in CKD patients with ergocalciferol: are current K/DOQI treatment guidelines adequate? AU - Qunibi,W Y, AU - Abdellatif,A, AU - Sankar,S, AU - Hamdan,Z, AU - Lin,F-Y, AU - Ingle,J, AU - Cadena,A, AU - Gelfond,J, AU - Kasinath,B, PY - 2010/4/1/entrez PY - 2010/4/1/pubmed PY - 2010/5/12/medline SP - 276 EP - 85 JF - Clinical nephrology JO - Clin. Nephrol. VL - 73 IS - 4 N2 - BACKGROUND: Vitamin D deficiency/insufficiency (VDDI) is common in CKD patients and may be associated with abnormal mineral metabolism. It is not clear whether the K/DOQI recommended doses of ergocalciferol are adequate for correction of VDDI and hyperparathyroidism. METHODS: Retrospective study of 88 patients with CKD Stages 1 - 5 and baseline 25-hydroxyvitamin D level < 30 ng/ml (< 75 nmol/l). Patients treated with ergocalciferol as recommended by K/DOQI guidelines. Only 53 patients had elevated baseline PTH level for the CKD stage. Patients were excluded if they received vitamin D preparations other than ergocalciferol or phosphate binders. 25-hydroxyvitamin D level, intact PTH level (iPTH), and other parameters of mineral metabolism were measured at baseline and after completion of ergocalciferol course. RESULTS: 88 patients with CKD were treated with ergocalciferol. Mean age 56.8 +/- 9.5 years and 41% were males. The mean (+/- SD) GFR was 28.3 +/- 16.6 ml/min. At the end of the 6-month period of ergocalciferol treatment, the mean 25-hydroxyvitamin D level increased from 15.1 +/- 5.8 to 23.3 +/- 11.8 ng/ml (37.75 +/- 14.5 to 58.25 +/- 29.5 nmol/l) (p < 0.001). Treatment led to > or = 5 ng/ml (12.5 nmol/l) increases in 25-hydroxyvitamin D level in 54% of treated patients, and only 25% achieved levels > or = 30 ng/ml (75 nmol/l). Mean iPTH level decreased from 157.9 +/- 125.9 to 150.7 +/- 127.5 pg/ml (p = 0.5). Only 26% of patients had > or = 30% decrease in their iPTH level after treatment with ergocalciferol. CONCLUSIONS: Current K/DOQI guidelines are inadequate for correcting VDDI or secondary hyperparathyroidism in CKD patients. Future studies should examine the effects of higher or more frequent dosing of ergocalciferol on these clinical endpoints. SN - 0301-0430 UR - https://www.unboundmedicine.com/medline/citation/20353735/Treatment_of_vitamin_D_deficiency_in_CKD_patients_with_ergocalciferol:_are_current_K/DOQI_treatment_guidelines_adequate L2 - http://www.dustri.com/nc/journals-in-english.html?artId=7459 DB - PRIME DP - Unbound Medicine ER -