Qunibi W Y, Abdellatif A, Sankar S, Hamdan Z, Lin F-Y, Ingle J, Cadena A, Gelfond J, Kasinath B
Nephrology Division, Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Clin Nephrol. 2010 Apr;73(4):276-85. doi: 10.5414/cnp73276.
Vitamin D deficiency/insufficiency (VDDI) is common in CKD patients and may be associated with abnormal mineral metabolism. It is not clear whether the K/DOQI recommended doses of ergocalciferol are adequate for correction of VDDI and hyperparathyroidism.
Retrospective study of 88 patients with CKD Stages 1 - 5 and baseline 25-hydroxyvitamin D level < 30 ng/ml (< 75 nmol/l). Patients treated with ergocalciferol as recommended by K/DOQI guidelines. Only 53 patients had elevated baseline PTH level for the CKD stage. Patients were excluded if they received vitamin D preparations other than ergocalciferol or phosphate binders. 25-hydroxyvitamin D level, intact PTH level (iPTH), and other parameters of mineral metabolism were measured at baseline and after completion of ergocalciferol course.
88 patients with CKD were treated with ergocalciferol. Mean age 56.8 +/- 9.5 years and 41% were males. The mean (+/- SD) GFR was 28.3 +/- 16.6 ml/min. At the end of the 6-month period of ergocalciferol treatment, the mean 25-hydroxyvitamin D level increased from 15.1 +/- 5.8 to 23.3 +/- 11.8 ng/ml (37.75 +/- 14.5 to 58.25 +/- 29.5 nmol/l) (p < 0.001). Treatment led to > or = 5 ng/ml (12.5 nmol/l) increases in 25-hydroxyvitamin D level in 54% of treated patients, and only 25% achieved levels > or = 30 ng/ml (75 nmol/l). Mean iPTH level decreased from 157.9 +/- 125.9 to 150.7 +/- 127.5 pg/ml (p = 0.5). Only 26% of patients had > or = 30% decrease in their iPTH level after treatment with ergocalciferol.
Current K/DOQI guidelines are inadequate for correcting VDDI or secondary hyperparathyroidism in CKD patients. Future studies should examine the effects of higher or more frequent dosing of ergocalciferol on these clinical endpoints.
维生素D缺乏/不足（VDDI）在慢性肾脏病（CKD）患者中很常见，可能与矿物质代谢异常有关。目前尚不清楚美国肾脏病基金会（K/DOQI）推荐剂量的麦角钙化醇是否足以纠正VDDI和甲状旁腺功能亢进。
对88例CKD 1 - 5期且基线25 - 羟维生素D水平<30 ng/ml（<75 nmol/l）的患者进行回顾性研究。患者按照K/DOQI指南接受麦角钙化醇治疗。仅53例患者因CKD分期基线甲状旁腺激素（PTH）水平升高纳入研究。若患者接受了除麦角钙化醇或磷结合剂以外的维生素D制剂，则被排除。在基线和麦角钙化醇疗程结束后，测量25 - 羟维生素D水平、完整PTH水平（iPTH）以及其他矿物质代谢参数。
88例CKD患者接受了麦角钙化醇治疗。平均年龄56.8±9.5岁，41%为男性。平均（±标准差）肾小球滤过率（GFR）为28.3±16.6 ml/min。在麦角钙化醇治疗6个月结束时，平均25 - 羟维生素D水平从15.1±5.8 ng/ml（37.75±14.5 nmol/l）升至23.3±11.8 ng/ml（58.25±29.5 nmol/l）（P<0.001）。治疗使54%的患者25 - 羟维生素D水平升高≥5 ng/ml（12.5 nmol/l），仅有25%的患者达到≥30 ng/ml（75 nmol/l）的水平。平均iPTH水平从157.9±125.9降至150. ±127.5 pg/ml（P = 0.5）。麦角钙化醇治疗后，仅26%的患者iPTH水平下降≥30%。
目前的K/DOQI指南不足以纠正CKD患者的VDDI或继发性甲状旁腺功能亢进。未来的研究应探讨更高剂量或更频繁给药的麦角钙化醇对这些临床终点的影响。
