Ergocalciferol treatment does Not improve erythropoietin utilization and hospitalization rate in hemodialysis patients

Background: Vitamin D (25-hydroxyvitamin D; 25[OH] D) deficiency (VDD) is highly prevalent in chronic kidney disease. The aim of this study was to evaluate the effect of oral ergocalciferol supplementation on requirement of erythropoietin (EPO) and active vitamin D analogues, and hospitalization rate in maintenance hemodialysis (HD) patients. Methods: This retrospective cohort study included 186 patients who were on HD for 3 months and had 25(OH) D levels < 30 ng/ml. Over 1-year period, 107 patients were supplemented with protocol-based ergocalciferol (D-2 group) and 79 were not (control). Parameters of erythropoiesis and bone-mineral metabolism, and monthly doses of EPO and paricalcitol were assessed at 6- and 12-months of ergocalciferol supplementation. Total hospitalizations were recorded for the same year. Results: Baseline characteristics were similar across two arms except higher serum ferritin, transferrin saturation and prevalence of stroke in D-2 and higher coronary artery disease in control group with overall mean +/- SD 25(OH) D level of 16.8 +/- 7 ng/ml. At 12 months, 25(OH) D levels increased significantly in D-2 group compared to control (30.5 +/- 11.7 vs. 14.2 +/- 9.3 ng/ml; p < 0.001). The EPO dose remained same with no difference in hemoglobin values between the two groups during the intervention period. On multivariate regression which included above variables there was no effect of ergocalciferol treatment on EPO dose (p = ns). Hospitalization rate was similar in two arms; however, ergocalciferol treatment inversely associated with paricalcitol dose (beta +/- SE = -10. 4 +/- 2.8; p < 0.001). Conclusions: One-year of ergocalciferol supplementation was not associated with reduction in EPO requirement or hospitalization rate in HD patients with VDD. Further studies are warranted to determine definitive role of nutritional vitamin D in these patients.