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Cholecalciferol v. ergocalciferol for 25-hydroxyvitamin D (25(OH)D) repletion in chronic kidney disease: a randomised clinical trial.
Br J Nutr. 2016 Dec; 116(12):2074-2081.BJ

Abstract

Patients with chronic kidney disease (CKD) demonstrate complex mineral metabolism derangements and a high prevalence of vitamin D deficiency. However, the optimal method of 25-hydroxyvitamin D (25(OH)D) repletion is unknown, and trials analysing the comparative efficacy of cholecalciferol and ergocalciferol in this population are lacking. We conducted a randomised clinical trial of cholecalciferol 1250μg (50 000 IU) weekly v. ergocalciferol 1250μg (50 000 IU) weekly for 12 weeks in forty-four non-dialysis-dependent patients with stage 3-5 CKD. The primary outcome was change in total 25(OH)D from baseline to week 12 (immediately after therapy). Secondary analyses included the change in 1,25-dihydroxyvitamin D (1,25(OH)2D), parathyroid hormone (PTH), D2 and D3 sub-fractions of 25(OH)D and 1,25(OH)2D and total 25(OH)D from baseline to week 18 (6 weeks after therapy). Cholecalciferol therapy yielded a greater change in total 25(OH)D (45·0 (sd 16·5) ng/ml) v. ergocalciferol (30·7 (sd 15·3) ng/ml) from baseline to week 12 (P<0·01); this observation partially resulted from a substantial reduction in the 25(OH)D3 sub-fraction with ergocalciferol. However, following cessation of therapy, no statistical difference was observed for total 25(OH)D change from baseline to week 18 between cholecalciferol and ergocalciferol groups (22·4 (sd 12·7) v. 17·6 (sd 8·9) ng/ml, respectively; P=0·17). We observed no significant difference between these therapies with regard to changes in serum PTH or 1,25(OH)2D. Therapy with cholecalciferol, compared with ergocalciferol, is more effective at raising serum 25(OH)D in non-dialysis-dependent CKD patients while active therapy is ongoing. However, levels of 25(OH)D declined substantially in both arms following cessation of therapy, suggesting the need for maintenance therapy to sustain levels.

Authors+Show Affiliations

1Hennepin County Medical Center,Division of Nephrology,Minneapolis,MN55415,USA.2Division of Nephrology & Hypertension,University of Kansas Medical Center,Kansas City,KS 66160,USA.4Department of Biostatistics,University of Kansas Medical Center,Kansas City,KS 66160,USA.2Division of Nephrology & Hypertension,University of Kansas Medical Center,Kansas City,KS 66160,USA.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28065190

Citation

Wetmore, James B., et al. "Cholecalciferol V. Ergocalciferol for 25-hydroxyvitamin D (25(OH)D) Repletion in Chronic Kidney Disease: a Randomised Clinical Trial." The British Journal of Nutrition, vol. 116, no. 12, 2016, pp. 2074-2081.
Wetmore JB, Kimber C, Mahnken JD, et al. Cholecalciferol v. ergocalciferol for 25-hydroxyvitamin D (25(OH)D) repletion in chronic kidney disease: a randomised clinical trial. Br J Nutr. 2016;116(12):2074-2081.
Wetmore, J. B., Kimber, C., Mahnken, J. D., & Stubbs, J. R. (2016). Cholecalciferol v. ergocalciferol for 25-hydroxyvitamin D (25(OH)D) repletion in chronic kidney disease: a randomised clinical trial. The British Journal of Nutrition, 116(12), 2074-2081. https://doi.org/10.1017/S000711451600427X
Wetmore JB, et al. Cholecalciferol V. Ergocalciferol for 25-hydroxyvitamin D (25(OH)D) Repletion in Chronic Kidney Disease: a Randomised Clinical Trial. Br J Nutr. 2016;116(12):2074-2081. PubMed PMID: 28065190.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cholecalciferol v. ergocalciferol for 25-hydroxyvitamin D (25(OH)D) repletion in chronic kidney disease: a randomised clinical trial. AU - Wetmore,James B, AU - Kimber,Cassandra, AU - Mahnken,Jonathan D, AU - Stubbs,Jason R, Y1 - 2017/01/09/ PY - 2017/1/10/pubmed PY - 2017/5/13/medline PY - 2017/1/10/entrez KW - 1 KW - 25(OH)D 25-hydroxyvitamin D KW - CKD chronic kidney disease KW - 25(OH)2D 1 KW - 25-Hydroxyvitamin D KW - 25-dihydroxyvitamin D KW - Cholecalciferol KW - Chronic kidney disease KW - Ergocalciferol KW - Vitamin D SP - 2074 EP - 2081 JF - The British journal of nutrition JO - Br J Nutr VL - 116 IS - 12 N2 - Patients with chronic kidney disease (CKD) demonstrate complex mineral metabolism derangements and a high prevalence of vitamin D deficiency. However, the optimal method of 25-hydroxyvitamin D (25(OH)D) repletion is unknown, and trials analysing the comparative efficacy of cholecalciferol and ergocalciferol in this population are lacking. We conducted a randomised clinical trial of cholecalciferol 1250μg (50 000 IU) weekly v. ergocalciferol 1250μg (50 000 IU) weekly for 12 weeks in forty-four non-dialysis-dependent patients with stage 3-5 CKD. The primary outcome was change in total 25(OH)D from baseline to week 12 (immediately after therapy). Secondary analyses included the change in 1,25-dihydroxyvitamin D (1,25(OH)2D), parathyroid hormone (PTH), D2 and D3 sub-fractions of 25(OH)D and 1,25(OH)2D and total 25(OH)D from baseline to week 18 (6 weeks after therapy). Cholecalciferol therapy yielded a greater change in total 25(OH)D (45·0 (sd 16·5) ng/ml) v. ergocalciferol (30·7 (sd 15·3) ng/ml) from baseline to week 12 (P<0·01); this observation partially resulted from a substantial reduction in the 25(OH)D3 sub-fraction with ergocalciferol. However, following cessation of therapy, no statistical difference was observed for total 25(OH)D change from baseline to week 18 between cholecalciferol and ergocalciferol groups (22·4 (sd 12·7) v. 17·6 (sd 8·9) ng/ml, respectively; P=0·17). We observed no significant difference between these therapies with regard to changes in serum PTH or 1,25(OH)2D. Therapy with cholecalciferol, compared with ergocalciferol, is more effective at raising serum 25(OH)D in non-dialysis-dependent CKD patients while active therapy is ongoing. However, levels of 25(OH)D declined substantially in both arms following cessation of therapy, suggesting the need for maintenance therapy to sustain levels. SN - 1475-2662 UR - https://www.unboundmedicine.com/medline/citation/28065190/Cholecalciferol_v__ergocalciferol_for_25_hydroxyvitamin_D__25_OH_D__repletion_in_chronic_kidney_disease:_a_randomised_clinical_trial_ L2 - https://www.cambridge.org/core/product/identifier/S000711451600427X/type/journal_article DB - PRIME DP - Unbound Medicine ER -