Introduction:

Patients on haemodialysis (HD) have a high prevalence of 25-OH-vitamin D (25-OH-D)deficiency. Secondary hyperparathyroidismis a common condition in these patients, which is very important to control. 25-OH-D is involved in regulating calcium homeostasis. As such, appropriate levels of this vitamin could help to control bone mineral metabolism.

Objective:

To evaluate the effect 25-OH-D repletion in HD patients with 25-OH-D deficiency (< 20 ng/ml) on the control of secondary hyperparathyroidism and microinflammation status.

Patients and methods:

Prospective observational study in which stable patients on HD with 25-OH-D deficiency (< 20 ng/ml) were treated with oral calcifediol 0.266 mcg/every 2 weeks for three months. Dialysis characteristics, biochemical parameters and drug doses administered were analysed before and after the correction of the deficiency.

Results:

Forty-five stable HD patients with a mean age of 74.08 ± 12.49 years completed treatment. Twenty-seven patients (60%) achieved 25-OH-D levels above 20 ng/ml (23 with levels > 30 ng/ml and 4 between 20-30 ng/ml). Parathyroid hormone levels decreased in 32 of the 45 patients, 23 of which (51%) achieved a > 30% decrease from baseline. In terms of concomitant treatment, we observed a significant reduction in the selective vitamin D receptor activator dose, but no changes in calcimimetic or phosphate binders administration. In terms of malnutrition-inflammation status, a decrease in C-reactive protein was noted, although other microinflammation parameters, such as activated monocytes (CD14+/CD16+ and CD 14++/CD16+) were unchanged. No changes were observed in the levels of FGF-23.

Conclusions:

Correcting 25-OH-D deficiency in HD patients is associated with better secondary hyperparathyroidism control with lower doses of vitamin D analogues, as well as an improvement in inflammatory status. Our results support the recommendation to determine 25-OH-D levels and correct its deficiency in these patients.

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