Kidney Week

Abstract: SA-PO695

Evaluation of Long Term Supplementation with Cholecalciferol on the Levels of 25-Hydroxyvitamin D (25[OH]D) and on Bone Turnover Biomarkers of Chronic Hemodialysis Patients

Session Information

• Bone and Mineral Metabolism: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Bozikas, Andreas, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Andreas Bozikas,

• Kiriakoutzik, Iliana, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Iliana Kiriakoutzik,

• Kitoukidi, Eleni, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Eleni Kitoukidi,

• Pisanidou, Pinelopi, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Pinelopi Pisanidou,

• Vakiani, Styliani, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Styliani Vakiani,

• Martika, Antigoni, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Antigoni Martika,

• Georgilas, Nikolaos, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Nikolaos Georgilas,

• Pangidis, Panagiotis, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Panagiotis Pangidis,

• Tsitouridis, Konstantinos, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Konstantinos Tsitouridis,

• Koteli, Asimoula, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Asimoula Koteli,

• Spaia, Sofia, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece

Sofia Spaia,

Background

We addressed the safety of long term supplementation with cholecalciferol in maintenance hemodialysis patients along with its effect on markers of bone and mineral metabolism.

Methods

Sixty stable hemodialysis patients, initially, received a dose of 1200 IU of cholecalciferol orally, once daily, every 48 hours, for 18 months. This dose was, subsequently, increased to 1200 IU, once daily for another 6 months.
25[OH]D levels were measured at 0, 4, 12, 18, and 24 months along with Ca, P, ALP, iPTH, HbA1c levels and BMI.
Additionally, all patients had a T – score evaluation by dual – energy x – ray absorptiometry (DXA) at the beginning of the study and after 12 and 24 months.

Results

All patients proved to be 25[OH]D deficient, regardless that measurements were done during the summer period (increasd sunlight). There was no correlation of the low 25[OH]D levels with age, sex, time on hemodialysis and HbA1c levels, but they did correlate to BMI, implicating diet as a source of 25[OH]D. Likewise, we observed no correlation with the administration of phosphate binders, statins or vitamin D receptor activators.
Alternate day supplementation improved 25[OH]D levels, which evolved from the deficient level to stage of insufficiency (p<0.01).
Daily administration – after 18 months – was achieved by 46 patients (76%).
Annual screening of bone density revealed gradual amelioration of T – score (p<0.01). No significant changes of the other markers were observed.

Conclusion

In conclusion, the very low levels of calcidiol in dialysis patients should draw considerable attention.
A “safe” threshold of 20 ng/ml was achieved by choosing the alternate day supplementation of 1200 IU of cholecalciferol, with no particular financial burden and succeeding compliance. The positive effect on bone density which was shown in this long term study regards more extended research. Although supplementation with calcidiol is not considered to be an essential treatment, yet, we consider that there are sufficient data to support long term supplementation of 25[OH]D for maintenance dialysis patients.