High-dose cholecalciferol reduces parathyroid hormone in patients with early chronic kidney disease: a pilot, randomized, double-blind, placebo-controlled trial

• Authors: Jessica A. Alvarez, Emory University; Jennie Law, Emory University; Kathryn E Coakley, Emory University; Susu M Zughaier, Emory University; Li Hao, Emory University; Khadijeh Shahid Salles, Atlanta Veterans Affairs Medical Center; Monnie Wasse, Emory University; Orlando M Gutierrez, University of Alabama at Birmingham; Thomas R Ziegler, Emory University; Vin Tangpricha, Emory University
• Journal Title: American Journal of Clinical Nutrition
• Volume: Volume 96, Number 3
• Publisher: American Society for Nutrition | 2012-09, Pages 672-679
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.3945/ajcn.112.040642
• Subjects: Biology, Physiology

Abstract

Background: Vitamin D deficiency contributes to secondary hyperparathyroidism, which occurs early in chronic kidney disease (CKD). Objectives: We aimed to determine whether high-dose cholecalciferol supplementation for 1 y in early CKD is sufficient to maintain optimal vitamin D status (serum 25-hydroxyvitamin D [25(OH)D] concentration ≥30 ng/mL) and decrease serum parathyroid hormone (PTH). A secondary aim was to determine the effect of cholecalciferol on blood pressure and serum fibroblast growth factor-23 (FGF23). Design: This was a double-blind, randomized, placebo-controlled trial. Forty-six subjects with early CKD (stages 2–3) were supplemented with oral cholecalciferol (vitamin D group; 50,000 IU/wk for 12 wk followed by 50,000 IU every other week for 40 wk) or a matching placebo for 1 y. Results: By 12 wk, serum 25(OH)D increased in the vitamin D group only [baseline (mean ± SD): 26.7 ± 6.8 to 42.8 ± 16.9 ng/mL; P < 0.05] and remained elevated at 1 y (group-by-time interaction: P < 0.001). PTH decreased from baseline only in the vitamin D group (baseline: 89.1 ± 49.3 to 70.1 ± 24.8 pg/mL; P = 0.01) at 12 wk, but values were not significantly different from baseline at 1 y (75.4 ± 29.5 pg/mL; P = 0.16; group-by-time interaction: P = 0.09). Group differences were more pronounced in participants with secondary hyperparathyroidism (group-by-time interaction: P = 0.004). Blood pressure and FGF23 did not change in either group. Conclusions: After 1 y, this oral cholecalciferol regimen was safe and sufficient to maintain serum 25(OH)D concentrations and prevent vitamin D insufficiency in early CKD. Furthermore, serum PTH improved after cholecalciferol treatment, particularly in patients who had secondary hyperparathyroidism. This trial was registered at clinicaltrials.gov as NCT00427037.