Native vs. active vitamin D in children with chronic kidney disease: a cross-over study
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ORIGINAL ARTICLE
Native vs. active vitamin D in children with chronic kidney disease: a cross-over study Happy Sawires 1
&
Fatina Fadel 1 & Ahmed Hussein 1 & Rasha Helmy 1
Received: 22 March 2020 / Revised: 13 June 2020 / Accepted: 21 July 2020 # IPNA 2020
Abstract Background The rationale for the prescription of vitamin D analogues in patients with chronic kidney disease (CKD) is still a matter of debate. We aimed to compare native vs. active forms of vitamin D on pre-dialysis children with CKD and evaluate effects on calcium (Ca), phosphorus (P), and parathyroid hormone (PTH). Methods Thirty children with pre-dialysis CKD were enrolled in a prospective cross-over study. Patients were randomly classified into two groups. Group A received native cholecalciferol while group B received alfacalcidol for 3 months. After 1 month (washout period), patients were switched to receive the opposite form for another 3 months. Serum Ca, P, alkaline phosphatase (ALP), PTH, and 25(OH)D3 were measured at study start (BL-1), end of first period (FU-1), before second period (BL-2), and after second period (FU-2). Results There was significant increase in levels of 25(OH)D3 after administration of either native or active vitamin D in the first period in both groups (p < 0.001 and < 0.001, respectively) and also in the second period for both groups (p = 0.02 and < 0.001, respectively). There was no significant difference between both groups regarding changes in serum Ca (1st period; p = 0.770 and 2nd period; p = 0.412), serum P (1st period; p = 0.835, 2nd period; p = 0.052), and serum PTH (1st period; p = 0.250, 2nd period; p = 0.539). Conclusion Alfacalcidol and native vitamin D3 were equally effective in decreasing PTH levels and increasing serum 25(OH)D3 in pre-dialysis CKD patients. There was no significant difference between the two forms regarding changes in serum Ca or P.
Keywords Cholecalciferol . Alfacalcidol . Pre-dialysis . 25(OH)D3 . Parathyroid hormone . Children
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04721-1) contains supplementary material, which is available to authorized users. * Happy Sawires [email protected] Fatina Fadel [email protected] Ahmed Hussein [email protected] Rasha Helmy [email protected] 1
Pediatric Nephrology Department, Cairo University, 5 El-Lithy Street El-Maadi El-Gedida, Cairo 11435, Egypt
Vitamin D deficiency or insufficiency is common in chronic kidney disease (CKD), affecting more than 80% of CKD patients without kidney replacement therapy (KRT) [1]. Although the exact mechanisms responsible for vitamin D deficiency are not fully understood, there is a strong inverse association between serum 25(OH)D3 and both morbidity and mortality in CKD patients [2, 3]. Recently, native vitamin D supplementation (ergocalciferol or cholecalciferol) has been of increasing interest since the presence of 1-α-hydroxylase enzyme activity in extra-renal cells was reported, raising the possibility of peripheral
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