Prevalence of vitamin D deficiency and the safety and effectiveness of monthly ergocalciferol in hemodialysis patients

Background: Vitamin D deficiency is common in CKD and dialysis patients. Studies suggest a physiologic autocrine and/ or paracrine role for 1,25(OH) D produced via 1 alpha-hydroxylase in tissues such as vascular smooth muscle, breast, prostate, and bone marrow. Studies have not yet defined the optimal dose and duration of vitamin D necessary to replete and maintain stores in dialysis patients, or whether it is safe or beneficial. Methods: We performed a review of the prevalence of vitamin D deficiency and the safety and effectiveness of ergocalciferol oral supplementation (vitamin D-2, 50,000 IU monthly) given to hemodialysis patients during dialysis May to October 2005 in St. Louis (latitude 38 degrees). Results: Among the 119-patient cohort present for the entire 6 months, 25(OH) D was (mean +/- SD) 16.9 +/- 8.5 ng/ ml, (91% < 30 ng/ ml) and increased to 53.6 +/- 16.3 ng/ ml (p < 0.001), (95% > 30 ng/ ml, and none 1 100 ng/ ml). Initial versus 6 mo. serum calcium (9.1 +/- 0.56 vs. 9.2 +/- 0.70), phosphorus (5.25 +/- 1.38 vs. 5.11 +/- 1.31), Ca ! P, and paricalcitol dose (10.3 +/- 9.6 vs. 11.3 +/- 9.2 mcg/ week) were not significantly different. No hypercalcemia could be attributed to supplementation. Mean hemoglobin did not change significantly (11.96 +/- 1.4 vs. 11.69 +/- 1.4, p = 0.124), but most patients experienced a reduced weekly epoetin dose. Epoetin dose decreased in 64% of patients, and increased in 28%. Conclusions: We conclude that the vast majority of hemodialysis patients are vitamin D-deficient; monthly ergocalciferol 50,000 IU is safe and effective in normalizing serum 25(OH) D levels and may have an epoetin-sparing effect. Copyright (c) 2007 S. Karger AG, Basel.