Abstract: SA-PO260
Effect of Transition from Vitamin D2 to Vitamin D3 Supplementation on Serum 25(OH)D Levels in Patients on Chronic In-Center Hemodialysis
Session Information
- Bone and Mineral Metabolism: Calcium, Magnesium, Kidney Stones
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Chuu, Andy, Washington University in St. Louis, St. Louis, Missouri, United States
- Ramakrishnan, Madhuri, Washington University in St. Louis, St. Louis, Missouri, United States
- Coyne, Daniel W., Washington University in St. Louis, St. Louis, Missouri, United States
Background
Vitamin D deficiency (25(OH)D <12 ng/ml) can lead to osteomalacia in adults, and insufficiency (12 to 20 ng/ml) is associated with osteoporosis, increased falls, and possibly fractures. Clinical guidelines (KDIGO 2017) recommend correction of Vitamin D deficiency and insufficiency in all CKD 3-5D patients. Short-term pharmacokinetic studies in healthy adults have shown that Vitamin D2 (VitD2) is less effective at correcting 25(OH)D levels than Vitamin D3 (VitD3). We evaluated whether conversion from VitD2 therapy to VitD3 resulted in a meaningful change in 25(OH)D levels in hemodialysis (HD) patients.
Methods
Since 2006, we have directly administered 50,000 units of VitD2 monthly to all ~160 in-center dialysis patients. In June 2017, we converted to 50,000 units monthly of VitD3. We collected demographic and laboratory data from 2016 and 2017 (VitD2 dosing), and 2018-2019 (VitD3 dosing). 25(OH)D was measured each April at Quest laboratories. Assay detects both 25(OH)D2 and 25(OH)D3. Changes in 25(OH)D levels were analyzed, and relationships to demographic and other laboratory parameters were explored.
Results
156 to 174 patients were included in each yearly analysis. Mean 25(OH)D levels (ng/ml) were 34.6 (2016) and 36.6 (2017) on VitD2. Levels increased to 52.9 (2018) and 53.7 (2019) on VitD3 (p<0.001). Use of VitD3 greatly reduced the proportion of patients with 25(OH)D 20-30ng/ml (29% pre; <1% post), but increased 25(OH)D levels >50 from 7% to 55%, and levels >80 from 0.3% to 4%. Among 96 patients present all 4 years, the results were similar (mean 35.2 on VitD2, and 55.0 on VitD3). There was no significant change in Calcium, PTH, or Alkaline Phosphatase
Conclusion
Consistent with short-term studies in healthy adults, at equal doses, VitD3 led to significantly higher 25(OH)D levels than VitD2. As 25(OH)D levels >20 ng/ml are sufficient to prevent osteomalacia, our data suggest use of either 50,000 units of VitD2 monthly, or a lower dose of VitD3 (likely 20-30,000 units monthly) is sufficient to prevent Vitamin D deficiency in HD patients.
Figure 1
| 2016 | 2017 | 2018 | 2019 | p-value | |
| Vitamin D (ng/dL) | 34.6 | 36.6 | 52.9 | 53.7 | <0.001* |
| Calcium (mg/dL) | 9.2 | 9.2 | 9.3 | 9.2 | 0.219 |
| PTH (pg/mL) | 450.2 | 517.2 | 471.1 | 575.5 | 0.217 |
| Alk Phos (U/L) | 94.3 | 97.6 | 89.2 | 96.4 | 0.542 |