Nutrition Program, Federal University of São Paulo, São Paulo, Brazil.
Ann Nutr Metab. 2012;61(1):74-82. doi: 10.1159/000339618. Epub 2012 Aug 7.
BACKGROUND/AIMS: Hypovitaminosis D is highly prevalent among patients with chronic kidney disease (CKD) and has been associated with poor outcome. We aimed to test the effect of a protocol of cholecalciferol supplementation on the restoration of vitamin D status and on parathyroid hormone (PTH) levels in patients with CKD.
This was a prospective interventional study of 6 months. Forty-five CKD patients (stages 3 and 4) with 25-hydroxyvitamin D deficiency [25(OH)D <15 ng/ml] were included. Patients received a weekly dose of 50,000 IU of cholecalciferol during 3 months, and 50,000 IU/month thereafter for those who had achieved 25(OH)D ≥30 ng/ml.
At 3 months, 78% of the patients restored their vitamin D status. At 6 months, only 43% of those patients maintained adequate vitamin D status. PTH decreased at 3 months (p = 0.02) but returned to baseline levels after 6 months. Fibroblast growth factor 23 increased at 3 months (p = 0.001) and returned to initial levels at 6 months. No changes were found in serum 1,25(OH)(2)D, ionized calcium and phosphorus.
A weekly dose of 50,000 IU of cholecalciferol for 3 months restored the vitamin D status of most patients and led to a reduction in PTH. The monthly dose of 50,000 IU appears not to be sufficient to maintain the levels of 25(OH)D.
背景/目的：维生素 D 缺乏症在慢性肾脏病（CKD）患者中非常普遍，并且与不良预后相关。我们旨在测试补充胆钙化醇方案对 CKD 患者维生素 D 状态恢复和甲状旁腺激素（PTH）水平的影响。
这是一项为期 6 个月的前瞻性干预研究。纳入了 45 名患有 25-羟维生素 D 缺乏症[25（OH）D <15ng/ml]的 CKD 患者（3 期和 4 期）。患者在 3 个月内每周接受 50,000IU 的胆钙化醇剂量，此后对于那些达到 25（OH）D≥30ng/ml 的患者每月接受 50,000IU。
在 3 个月时，78%的患者恢复了维生素 D 状态。在 6 个月时，只有 43%的患者维持了足够的维生素 D 状态。PTH 在 3 个月时下降（p=0.02），但在 6 个月时恢复到基线水平。成纤维细胞生长因子 23 在 3 个月时增加（p=0.001），并在 6 个月时恢复到初始水平。血清 1,25（OH）（2）D、离子钙和磷没有变化。
每周一次给予 50,000IU 的胆钙化醇治疗 3 个月可恢复大多数患者的维生素 D 状态，并降低 PTH。每月给予 50,000IU 的剂量似乎不足以维持 25（OH）D 的水平。
