Cholecalciferol additively reduces serum parathyroid hormone levels in severe secondary hyperparathyroidism treated with calcitriol and cinacalcet among hemodialysis patients

Cai Mei Zheng, Chia Chao Wu, Chi Feng Hung, Min Tser Liao, Jia Fwu Shyu, Yung Ho Hsu, Chien Lin Lu, Yuan Hung Wang, Jing Quan Zheng, Tian Jong Chang, Yuh Feng Lin, Kuo Cheng Lu

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 Calcitriol was reduced if iPTH ≤ 300 pg/mL and cinacalcet was withdrawn if serum iPTH was persistently low (iPTH ≤ 300 pg/mL) for 4 weeks after the reduction of calcitriol.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 languageEnglish
Article number196
JournalNutrients
Volume10
Issue number2
DOIs
Publication statusPublished - 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

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