October - December 2018, Volume 14, Issue 4

Stancu S, Chiriac C, Maria DT, Mota E, Mircescu G, Capusa C

Nutritional or Active Vitamin D for the Correction of Mineral Metabolism Abnormalities in Non-Dialysis Chronic Kidney Disease Patients?

Acta Endo (Buc) 2018, 14 (4): 505-513
doi: 10.4183/aeb.2018.505

Context. Benefits of vitamin D therapies in chronic kidney disease (CKD) are debated. Objective. To compare the effects of medium-term native (VitD) and active (VDRA) vitamin D on parameters of mineral metabolism and arterial function in non-dialysis CKD. Design. Open-label, active comparator, randomized study. Subjects and Methods. Forty-eight adult patients, vitamin D naïve, CKD stage 3 to 5 with increased parathyroid hormone (iPTH) were randomized to receive either oral cholecalciferol 1000UI/day (n=24) or paricalcitol 1mcg/day (n=24) for 6 months. Median changes at end of study vs. baseline in serum calcidiol, iPTH, total alkaline phosphatase (ALP), and cardio-ankle vascular index (CAVI) were the efficacy parameters. Results. Higher increase in calcidiol (15.5 [95%CI 13.3; 17.2] vs. 0.4 [95%CI −6.1; 3.7]ng/mL, p<0.001) were found in VitD group. Conversely, the decline of iPTH (−35.2 [95%CI −83; 9] vs. 13.3 [95%CI −8.1; 35]pg/mL, p=0.008) and ALP (−34 [95%CI −58; −11] vs. −10 [95%CI −23; −2] U/L, p=0.02) were greater after paricalcitol. More subjects experienced iPTH decrease in VDRA group (71% vs. 39%, p=0.03). The variation in CAVI and the incidence of hypercalcemia and hyperphosphatemia were similar. Conclusions. It seems that secondary hyperparathyroidism was more efficiently treated by VDRA, whereas cholecalciferol better corrected the calcidiol deficiency in non-dialysis CKD.

Keywords: chronic kidney disease, native vitamin D, vitamin D receptor activators, secondary hyperparathyroidism, arterial stiffness.

Correspondence: Corina Chiriac MD, “Carol Davila” University of Medicine and Pharmacy, Nephrology Department, 8th Eroii Sanitari Avenue, Bucharest, 050474, Romania, E-mail: chirinacori@gmail.com