Abstract
Vitamin D (vitD) deficiency is frequently observed among dialysis patients. A significant number of evidences have been accumulated these recent years supporting the benefit of using vit D in hemodialysis patients. There has been renewed interest in studying the effects of supplementation with native vitamin D (Cholecalciferol) in CKD patients with low 25(OH) D levels and this interest has been fanned by studies that have demonstrated several potential non skeletal benefits of vitD. These benefits include effect of vitamin D on immune system, cardiovascular disease, diabetes, and some cancers. In Tunisia, there are no studies regarding hypovitaminosis D in patients with chronic Kidney disease (CKD) stage 5 on dialysis. The aim of this study is to evaluate the effect of oral Cholecalciferol supplementation, in intact parathormon hormon (iPTH), serum calcemium (Ca) and serum phosphorus (ph) in hemodialysis patients. We conducted a pre-experimental study among hemodialysis patients We included patients of CKD stage 5 who were on maintenance hemodialysis for more than one year. They were adults (age >18 years). Patients were not included if they had a history of active vitD or calcimimetic treatment in the last year, parathyroidectomy; iPTH <300pg/ml, hepatic failure or digestive malabsorption. Those with serum calcium greater than 2,55 mmol/l or phosphorus greater than 2 mmol / L were not included. The calcium concentration during hemodialysis sessions was set at 1.5 mmol for all the patients. Monthly Oral supplementation with Cholecalciferol (800000 UI in totality), was instituted for six months. Fourty three participants were included in the study. The mean 25 (OH) D concentration was 17,89 ng/ml. Vit D deficiency was observed in 83.7% of our patients. We observed a significant increase in 25OH vitD and Ca levels and significant decline in iPTH level. No evident toxicity, nor severe hypercalcemia or increase in phosphoremia was noted. This is the first Tunisian study regarding the prevalence of hypovitaminose D in patients on hemodialysis and the effects of vitD supplementation on mineral disorders. The supplementation with Cholecalciferol seems reasonable and well tolerated in HD patients if reasonable doses are used with regular monitoring to prevent the development of toxicity.
Published Version
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