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Cholecalciferol Additively Reduces Serum Parathyroid Hormone Levels in Severe Secondary Hyperparathyroidism Treated with Calcitriol and Cinacalcet among Hemodialysis Patients

Authors :
Jia Fwu Shyu
Yuh Feng Lin
Cai Mei Zheng
Yuan Hung Wang
Min Tser Liao
Chien Lin Lu
Tian Jong Chang
Chi Feng Hung
Kuo Cheng Lu
Chia-Chao Wu
Yung Ho Hsu
Jing Quan Zheng
Source :
Nutrients, Nutrients; Volume 10; Issue 2; Pages: 196
Publication Year :
2018
Publisher :
MDPI AG, 2018.

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 Calcitriol was reduced if iPTH ≤ 300 pg/mL and cinacalcet was withdrawn if serum iPTH was persistently low (iPTH ≤ 300 pg/mL) for 4 weeks after the reduction of calcitriol.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.

Details

ISSN :
20726643
Volume :
10
Database :
OpenAIRE
Journal :
Nutrients
Accession number :
edsair.doi.dedup.....9063dcae98959a36bd86fa26bd0cd2d6
Full Text :
https://doi.org/10.3390/nu10020196