MP363CHOLECALCIFEROL SUPPLEMENTATION IN HEMODIALYSIS: NO RISKS AND POSSIBLE NUTRITIONAL BENEFIT

Abstract

Introduction and Aims: Correction of vitamin D(VD) deficiency is suggested in stage 5D chronic kidney disease with no proposition of a specific treatment strategy. Serum 25‐hydroxyvitamin D3(25OHD) levels and various biochemistry parameter values were investigated in chronic hemodialysis(HD) patients during and after cholecalciferol supplementation. Methods: Thirty‐six patients [M/F: 24/12, 70(42‐87) years old] on HD treatment since 44(3‐222) months participated in a randomized controlled study. Group A(GA) included 19 patients treated with cholecalciferol orally, 2400IU thrice weekly after each HD session, for 3 months. Group B(GB) included 17 controls‐no treatment. All patients were studied for 8 months during both a 3‐month treatment period (April‐June) and a consecutive 5‐month observational period with no cholecalciferol supplementation (July‐November). Results: Baseline serum 25OHD levels were low in all participants (11,9±5,8ng/ml) with no difference between groups. At the end of the 3rd month serum 25OHD levels were increased in both groups (seasonal variation) but the increase was more significant in GA(11,1±5,7 to 27,4±7,9ng/ml‐p<0,001) compared to GB(12,8±5,9 to 17,2±6,9ng/ml‐p=0,005). At the end of the 8th month serum 25OHD levels were found decreased in both groups (seasonal variation) (GA:19,1±7,5ng/ml‐p<0,001, GB:8,3 ±7,3ng/ml‐p<0,001) being extremely low in GB, even lower than baseline levels (p=0,005). In contrary, in GA serum 25OHD levels were higher than baseline levels (p<0,001) and also significantly higher than those in GB at 3 months and at 8 months (p<0,001 respectively). The percentages of patients with serum 25OHD levels above 30ng/ml at 3 months and above 15ng/ml(VD deficiency‐insufficiency considered borderline) at 8 months were higher in GA compared with GB (42,1% vs 5,9%‐p=0,01 and 73,7,1% vs 17,6%‐p<0,001 respectively). There was no change in serum PTH, calcium corrected for albumin(Ca), phosphate(P), alkaline phosphatase activity, urea, creatinine, cholesterol and triglyceride levels in any group. Incidences of hypercalcemia and hyperphosphatemia and serum PTH levels were similar between groups. There was no need for decreases in dialysate calcium concentration and paricalcitol dosage. An elevation in serum albumin levels at 3 months was observed only in GA(3,4±0,3 to 3,5 ±0,3g/dl‐p=0,009) together with an increase in body weight (66,6±10,5 to 67,2 ±10,6kg‐p=0,03) with no significant variations in blood pressure values and no need of antihypertensive treatment reinforcement. Serum albumin and body weight values did not change at 8 months remaining higher than baseline respective values (3,5±0,3g/ dl‐p=0,04 and 67,4±10,8kg‐p=0,03). Conclusions: In conclusion, in a sunshine country, low dose cholecalciferol supplementation is a satisfactory, easy, safe and cost‐effective strategy for improving VD deficiency and probably nutritional status in HD patients. A higher cholecalciferol supplementation dosage could be further investigated for an optimal correction of VD deficiency in HD.