Tarasewicz Agnieszka, Komorniczak Michał, Zakrzewska Agnieszka, Biedunkiewicz Bogdan, Małgorzewicz Sylwia, Jankowska Magdalena, Jasiulewicz Katarzyna, Płonka Natalia, Dąbrowska Małgorzata, Dębska-Ślizień Alicja, Tylicki Leszek
Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland.
Department of Clinical Nutrition, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland.
Biomedicines. 2024 Feb 6;12(2):377. doi: 10.3390/biomedicines12020377.
Vitamin D deficiency and insufficiency are highly prevalent in CKD, affecting over 80% of hemodialysis (HD) patients and requiring therapeutic intervention. Nephrological societies suggest the administration of cholecalciferol according to the guidelines for the general population. The aim of the observational study was to evaluate the efficacy and safety of the therapy with a high dose of cholecalciferol in HD patients with 25(OH)D deficiency and insufficiency to reach the target serum 25(OH)D level > 30 ng/mL. A total of 22 patients (16 M), with an average age of 72.5 ± 13.03 years and 25(OH)D concentration of 13.05 (9.00-17.90) ng/mL, were administered cholecalciferol at a therapeutic dose of 70,000 IU/week (20,000 IU + 20,000 IU + 30,000 IU, immediately after each dialysis session). All patients achieved the target value > 30 ng/mL, with a mean time of 2.86 ± 1.87 weeks. In the first week, the target level of 25(OH)D (100%) was reached by 2 patients (9.09%), in the second week by 15 patients (68.18%), in the fourth week by 18 patients (81.18%), and in the ninth week by all 22 patients (100%). A significant increase in 1,25(OH)D levels was observed during the study. However, only 2 patients (9.09%) achieved a concentration of 1,25(OH)D above 25 ng/mL-the lower limit of the reference range. The intact PTH concentrations remained unchanged during the observation period. No episodes of hypercalcemia were detected, and one new episode of hyperphosphatemia was observed. In conclusion, our study showed that the administration of a high-therapeutic dose of cholecalciferol allowed for a quick, effective, and safe leveling of 25(OH)D concentration in HD patients.
维生素D缺乏和不足在慢性肾脏病中极为普遍，影响超过80%的血液透析（HD）患者，需要进行治疗干预。肾脏病学会建议根据普通人群的指南给予胆钙化醇。这项观察性研究的目的是评估高剂量胆钙化醇治疗对25(OH)D缺乏和不足的HD患者达到血清25(OH)D水平>30 ng/mL目标的疗效和安全性。共有22例患者（16例男性），平均年龄72.5±13.03岁，25(OH)D浓度为13.05（9.00 - 17.90）ng/mL，给予治疗剂量为70,000 IU/周的胆钙化醇（每次透析后立即给予20,000 IU + 20,000 IU + 30,000 IU）。所有患者均达到>30 ng/mL的目标值，平均时间为2.86±1.87周。在第一周，2例患者（9.09%）达到25(OH)D的目标水平（100%），第二周15例患者（68.18%）达到，第四周18例患者（81.18%）达到，第九周所有22例患者（100%）达到。研究期间观察到1,25(OH)D水平显著升高。然而，只有2例患者（9.09%）的1,25(OH)D浓度高于25 ng/mL（参考范围下限）。观察期内完整甲状旁腺激素浓度保持不变。未检测到高钙血症发作，观察到1例新的高磷血症发作。总之，我们的研究表明，给予高治疗剂量的胆钙化醇可使HD患者的25(OH)D浓度快速、有效且安全地达到目标水平。
