DeVille Jason, Thorp Micah L, Tobin Lois, Gray Eeva, Johnson Eric S, Smith David H
Department of Medicine, St. Vincent Medical Center, Kaiser Permanente Northwest, Portland, Oregon, USA.
Nephrology (Carlton). 2006 Dec;11(6):555-9. doi: 10.1111/j.1440-1797.2006.00698.x.
To assess the impact of the administration of ergocalciferol on serum parathyroid hormone levels at different stages of chronic kidney disease (CKD).
A continuous series of 85 patients with stages 3-5 CKD but excluding patients on dialysis referred to the Kaiser Kidney Program were followed. Baseline serum intact parathyroid hormone (iPTH) and serum 25(OH)D levels were measured. All patients were administered ergocalciferol in doses ranging from 800 iu/day to 100,000 iu/week. We obtained serum levels of iPTH and 25(OH)D for a post-treatment endpoint after a median treatment period of 90 days.
Pre- and post-treatment serum iPTH levels displayed a mean difference of 2.8 pmol/L (95% CI 1.3-4.4, P < 0.001). Patients with stage 4 CKD had a mean difference of 3.6 pmol/L (95% CI 1.7-5.5, P < 0.001) between pre- and post-iPTH levels. Serum iPTH levels decreased among CKD stages 3 and 5, but were not statistically significant. All CKD groups analysed in the present study had significant increases in serum 25(OH)D levels. None of the study population required cessation of vitamin D therapy and no adverse outcomes were reported.
Ergocalciferol supplementation appears a safe and effective treatment for CKD populations which may raise levels of serum 25(OH)D levels and decrease iPTH levels.
评估给予骨化醇对慢性肾脏病（CKD）不同阶段血清甲状旁腺激素水平的影响。
对连续纳入的85例3 - 5期CKD患者进行随访，但排除转诊至凯撒肾脏项目的透析患者。测定基线血清完整甲状旁腺激素（iPTH）和血清25(OH)D水平。所有患者接受剂量范围为800国际单位/天至100,000国际单位/周的骨化醇治疗。在中位治疗期90天后，我们获得了治疗后终点的iPTH和25(OH)D血清水平。
治疗前后血清iPTH水平的平均差异为2.8 pmol/L（95%置信区间1.3 - 4.4，P < 0.001）。4期CKD患者治疗前后iPTH水平的平均差异为3.6 pmol/L（95%置信区间1.7 - 5.5，P < 0.001）。3期和5期CKD患者的血清iPTH水平有所下降，但无统计学意义。本研究分析的所有CKD组血清25(OH)D水平均显著升高。研究人群中无一例需要停止维生素D治疗，也未报告不良结局。
补充骨化醇似乎是一种安全有效的CKD人群治疗方法，可能会提高血清25(OH)D水平并降低iPTH水平。
