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Conversion from Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis.
Clin J Am Soc Nephrol. 2020 03 06; 15(3):384-391.CJ

Abstract

BACKGROUND AND OBJECTIVES

In the United States, intravenous vitamin D analogs are the first-line therapy for management of secondary hyperparathyroidism in hemodialysis patients. Outside the United States, oral calcitriol (1,25-dihydroxyvitamin D3) is routinely used. We examined standard laboratory parameters of patients on in-center hemodialysis receiving intravenous vitamin D who switched to oral calcitriol.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We conducted a retrospective cohort study of adult patients treated within Fresenius Kidney Care clinics. During a 6-month period (December 2013 to May 2014), we identified patients on an intravenous vitamin D analog (doxercalciferol or paricalcitol) who switched to oral calcitriol and matched them to patients receiving an intravenous vitamin D analog. Mean serum calcium, phosphate, and intact parathyroid hormone (iPTH) concentrations were examined for up to 12 months of follow-up. We used Poisson and Cox proportional hazards regression models to examine hospitalization and survival rates. The primary analysis was conducted as intention-to-treat; secondary analyses included an as-treated evaluation.

RESULTS

A total of 2280 patients who switched to oral calcitriol were matched to 2280 patients receiving intravenous vitamin D. Compared with patients on intravenous vitamin D, mean calcium and phosphate levels in the oral calcitriol group were lower after the change to oral calcitriol. In contrast, iPTH levels were higher in the oral calcitriol group. At 12 months, the percentage of patients with composite laboratories in target range (calcium <10 mg/dl, phosphate 3.0-5.5 mg/dl, and iPTH 150-600 pg/ml) were comparable between groups (45% versus 45%; P=0.96). Hospital admissions, length of hospital stay, and survival were comparable between groups. An as-treated analysis and excluding those receiving cinacalcet did not reveal significant between-group differences.

CONCLUSIONS

Among patients receiving in-center hemodialysis who were switched to oral calcitriol versus those on an intravenous vitamin D analog, the aggregate of all mineral and bone laboratory parameters in range was largely similar between groups.

Authors+Show Affiliations

Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Fresenius Medical Care North America, Waltham, Massachusetts; and.Fresenius Medical Care North America, Waltham, Massachusetts; and.Fresenius Medical Care North America, Waltham, Massachusetts; and Len.Usvyat@fmc-na.com.Fresenius Medical Care North America, Waltham, Massachusetts; and.Fresenius Medical Care AG & Co., KGaA, Bad Homburg, Germany.Fresenius Medical Care North America, Waltham, Massachusetts; and.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32111702

Citation

Thadhani, Ravi I., et al. "Conversion From Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 15, no. 3, 2020, pp. 384-391.
Thadhani RI, Rosen S, Ofsthun NJ, et al. Conversion from Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis. Clin J Am Soc Nephrol. 2020;15(3):384-391.
Thadhani, R. I., Rosen, S., Ofsthun, N. J., Usvyat, L. A., Dalrymple, L. S., Maddux, F. W., & Hymes, J. L. (2020). Conversion from Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis. Clinical Journal of the American Society of Nephrology : CJASN, 15(3), 384-391. https://doi.org/10.2215/CJN.07960719
Thadhani RI, et al. Conversion From Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis. Clin J Am Soc Nephrol. 2020 03 6;15(3):384-391. PubMed PMID: 32111702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conversion from Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis. AU - Thadhani,Ravi I, AU - Rosen,Sophia, AU - Ofsthun,Norma J, AU - Usvyat,Len A, AU - Dalrymple,Lorien S, AU - Maddux,Franklin W, AU - Hymes,Jeffrey L, Y1 - 2020/02/28/ PY - 2019/07/10/received PY - 2020/01/16/accepted PY - 2020/3/1/pubmed PY - 2021/6/1/medline PY - 2020/3/1/entrez KW - 1 alpha-hydroxyergocalciferol KW - Mineral Bone Disorder KW - United States KW - Vitamin D KW - adult KW - calcitriol KW - calcium KW - calcium phosphates KW - cinacalcet KW - dihydroxy-vitamin D3 KW - ergocalciferols KW - follow-up studies KW - humans KW - intention to treat analysis KW - length of stay KW - minerals KW - parathyroid hormone KW - paricalcitol KW - phosphate KW - phosphates KW - renal dialysis KW - retrospective studies KW - secondary hyperparathyroidism KW - survival rate SP - 384 EP - 391 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 15 IS - 3 N2 - BACKGROUND AND OBJECTIVES: In the United States, intravenous vitamin D analogs are the first-line therapy for management of secondary hyperparathyroidism in hemodialysis patients. Outside the United States, oral calcitriol (1,25-dihydroxyvitamin D3) is routinely used. We examined standard laboratory parameters of patients on in-center hemodialysis receiving intravenous vitamin D who switched to oral calcitriol. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study of adult patients treated within Fresenius Kidney Care clinics. During a 6-month period (December 2013 to May 2014), we identified patients on an intravenous vitamin D analog (doxercalciferol or paricalcitol) who switched to oral calcitriol and matched them to patients receiving an intravenous vitamin D analog. Mean serum calcium, phosphate, and intact parathyroid hormone (iPTH) concentrations were examined for up to 12 months of follow-up. We used Poisson and Cox proportional hazards regression models to examine hospitalization and survival rates. The primary analysis was conducted as intention-to-treat; secondary analyses included an as-treated evaluation. RESULTS: A total of 2280 patients who switched to oral calcitriol were matched to 2280 patients receiving intravenous vitamin D. Compared with patients on intravenous vitamin D, mean calcium and phosphate levels in the oral calcitriol group were lower after the change to oral calcitriol. In contrast, iPTH levels were higher in the oral calcitriol group. At 12 months, the percentage of patients with composite laboratories in target range (calcium <10 mg/dl, phosphate 3.0-5.5 mg/dl, and iPTH 150-600 pg/ml) were comparable between groups (45% versus 45%; P=0.96). Hospital admissions, length of hospital stay, and survival were comparable between groups. An as-treated analysis and excluding those receiving cinacalcet did not reveal significant between-group differences. CONCLUSIONS: Among patients receiving in-center hemodialysis who were switched to oral calcitriol versus those on an intravenous vitamin D analog, the aggregate of all mineral and bone laboratory parameters in range was largely similar between groups. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/32111702/Conversion_from_Intravenous_Vitamin_D_Analogs_to_Oral_Calcitriol_in_Patients_Receiving_Maintenance_Hemodialysis_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=32111702 DB - PRIME DP - Unbound Medicine ER -