Journal
NUTRIENTS
Volume 10, Issue 2, Pages -Publisher
MDPI
DOI: 10.3390/nu10020196
Keywords
cholecalciferol; hemodialysis; secondary hyperparathyroidism; cinacalcet; calcitriol
Categories
Funding
- [CTH 105A-215]
- [CTH-106A-2B01]
- [103TMU-SHH-28]
- [CTH-100-1-2A0]
- [NC10003]
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We evaluated the improvement of intact parathyroid hormone (iPTH) levels and bone parameters by supplementing nutritional vitamin D (cholecalciferol) to combined calcimimetic (cinacalcet) and active vitamin D analog (calcitriol) among severe secondary hyperparathyroidism (SHPT) hemodialysis (HD) patients. A randomized, controlled open-label study was undertaken in 60 HD patients with serum iPTH > 1000 pg/mL or persistently high iPTH 600 pg/mL even after >3 months of calcitriol (3 g/week). The study group received oral cholecalciferol (5000 IU/ day) and the control group received a placebo. All patients received fixed dose cinacalcet (30 mg/day, orally) and calcitriol. Calcitriol was reduced if iPTH 300 pg/mL and cinacalcet was withdrawn if serum iPTH was persistently low (iPTH 300 pg/mL) for 4 weeks after the reduction of calcitriol. A significantly lower iPTH level was noted from the 20th week in the study group compared to the placebo group, and the target iPTH 300 pg/mL was achieved at the 24th week in the study group. Most patients achieved serum 25-(OH)D-3 30 ng/mL in the study group. Nearly 40% of study patients gained >10% improvement in femoral neck (FN) bone mineral density (BMD). We conclude that cholecalciferol additively reduced serum iPTH levels, improved 25-(OH)D-3 levels and improved FN BMD when used together with cinacalcet/calcitriol in severe SHPT HD patients.
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