Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency

Introduction: Low 25-hydroxyvitamin D (25(OH)D) level in hemodialysis (HD) patients is associated with high bone turnover, secondary hyperparathyroidism, and decreased bone mineral density (BMD). Objective: To investigate the efficacy of equivalent doses of pulse oral cholecalciferol versus intramus...

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Autores principales:	Maha A. Behairy, Reem M. Elsharabasy, Abdel Bassit El Shaarawy, Walid Anwar, Zeinab Ahmed Mahmoud, Lina Essam Khedr
Formato:	article
Lenguaje:	EN
Publicado:	Society of Diabetic Nephropathy Prevention 2022
Materias:	cholecalciferol hemodialysis 25 oh vitamin d hyperparathyroidism Therapeutics. Pharmacology RM1-950 Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/7bb597d410ea477b822ee4f5314e6524
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spelling	oai:doaj.org-article:7bb597d410ea477b822ee4f5314e65242021-11-17T08:15:00ZOral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency2345-420210.34172/npj.2022.07https://doaj.org/article/7bb597d410ea477b822ee4f5314e65242022-01-01T00:00:00Zhttps://jnephropharmacology.com/PDF/npj-10383https://doaj.org/toc/2345-4202Introduction: Low 25-hydroxyvitamin D (25(OH)D) level in hemodialysis (HD) patients is associated with high bone turnover, secondary hyperparathyroidism, and decreased bone mineral density (BMD). Objective: To investigate the efficacy of equivalent doses of pulse oral cholecalciferol versus intramuscular (IM) cholecalciferol in correcting serum 25(OH)D levels in HD patients with vitamin D deficiency. Patients and Methods: In a prospective randomized open-label clinical trial, 80 HD patients with 25(OH)D level <20 ng/mL and serum intact parathyroid hormone (iPTH) level >100 pg/mL were enrolled in the study. Patients were divided into two groups. Group I: 40 HD patients received oral cholecalciferol 25 000 IU weekly for 12 weeks. Group II: 40 HD patients received a single dose of IM cholecalciferol 300 000 IU. Patients were maintained on their regular medications as alfacalcidol or phosphate binders. Serum calcium, phosphorus, 25(OH)D, alkaline phosphatase and iPTH were monitored at 0, 6th, and 12th week of intervention. Results: Significant increase in serum 25(OH)D level in group II patients who received IM (intramuscular) cholecalciferol, with delta mean a change of vitamin D level was 2.92 ±7.29 ng/mL over three months in comparison to the insignificant change in oral cholecalciferol group. Additionally there was a significant increase in the mean of serum calcium in comparison to oral cholecalciferol group, while we found a statistically significant decrease in alkaline phosphatase level in both groups too (P<0.05). The mean of iPTH levels was reduced significantly with IM cholecalciferol dose (1064.00 ± 787.60 to 609.9 ± 551.41 pg/mL; P<0.05). Conclusion: Intramuscular cholecalciferol dose is more effective at increasing 25(OH) D levels in dialysis patients than oral supplementation, achieves more increase in serum calcium and reduce iPTH levels. However, the longer duration of treatment is required to achieve recommended levels of vitamin D and suppress high iPTH levels.Maha A. BehairyReem M. ElsharabasyAbdel Bassit El ShaarawyWalid AnwarZeinab Ahmed MahmoudLina Essam KhedrSociety of Diabetic Nephropathy Prevention articlecholecalciferolhemodialysis25 oh vitamin dhyperparathyroidismTherapeutics. PharmacologyRM1-950Diseases of the genitourinary system. UrologyRC870-923ENJournal of Nephropharmacology, Vol 11, Iss 1, Pp e7-e7 (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	cholecalciferol hemodialysis 25 oh vitamin d hyperparathyroidism Therapeutics. Pharmacology RM1-950 Diseases of the genitourinary system. Urology RC870-923
spellingShingle	cholecalciferol hemodialysis 25 oh vitamin d hyperparathyroidism Therapeutics. Pharmacology RM1-950 Diseases of the genitourinary system. Urology RC870-923 Maha A. Behairy Reem M. Elsharabasy Abdel Bassit El Shaarawy Walid Anwar Zeinab Ahmed Mahmoud Lina Essam Khedr Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency
description	Introduction: Low 25-hydroxyvitamin D (25(OH)D) level in hemodialysis (HD) patients is associated with high bone turnover, secondary hyperparathyroidism, and decreased bone mineral density (BMD). Objective: To investigate the efficacy of equivalent doses of pulse oral cholecalciferol versus intramuscular (IM) cholecalciferol in correcting serum 25(OH)D levels in HD patients with vitamin D deficiency. Patients and Methods: In a prospective randomized open-label clinical trial, 80 HD patients with 25(OH)D level <20 ng/mL and serum intact parathyroid hormone (iPTH) level >100 pg/mL were enrolled in the study. Patients were divided into two groups. Group I: 40 HD patients received oral cholecalciferol 25 000 IU weekly for 12 weeks. Group II: 40 HD patients received a single dose of IM cholecalciferol 300 000 IU. Patients were maintained on their regular medications as alfacalcidol or phosphate binders. Serum calcium, phosphorus, 25(OH)D, alkaline phosphatase and iPTH were monitored at 0, 6th, and 12th week of intervention. Results: Significant increase in serum 25(OH)D level in group II patients who received IM (intramuscular) cholecalciferol, with delta mean a change of vitamin D level was 2.92 ±7.29 ng/mL over three months in comparison to the insignificant change in oral cholecalciferol group. Additionally there was a significant increase in the mean of serum calcium in comparison to oral cholecalciferol group, while we found a statistically significant decrease in alkaline phosphatase level in both groups too (P<0.05). The mean of iPTH levels was reduced significantly with IM cholecalciferol dose (1064.00 ± 787.60 to 609.9 ± 551.41 pg/mL; P<0.05). Conclusion: Intramuscular cholecalciferol dose is more effective at increasing 25(OH) D levels in dialysis patients than oral supplementation, achieves more increase in serum calcium and reduce iPTH levels. However, the longer duration of treatment is required to achieve recommended levels of vitamin D and suppress high iPTH levels.
format	article
author	Maha A. Behairy Reem M. Elsharabasy Abdel Bassit El Shaarawy Walid Anwar Zeinab Ahmed Mahmoud Lina Essam Khedr
author_facet	Maha A. Behairy Reem M. Elsharabasy Abdel Bassit El Shaarawy Walid Anwar Zeinab Ahmed Mahmoud Lina Essam Khedr
author_sort	Maha A. Behairy
title	Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency
title_short	Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency
title_full	Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency
title_fullStr	Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency
title_full_unstemmed	Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency
title_sort	oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin d deficiency
publisher	Society of Diabetic Nephropathy Prevention
publishDate	2022
url	https://doaj.org/article/7bb597d410ea477b822ee4f5314e6524
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Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency

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