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Submitted: 20 Jan 2021
Accepted: 17 May 2021
ePublished: 19 Jun 2021
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J Nephropharmacol. 2022;11(1): e7-e7.
doi: 10.34172/npj.2022.07
  Abstract View: 231
  PDF Download: 71

Original

Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency

Maha A. Behairy 1 * ORCID logo, Reem M. Elsharabasy 1, Abdel Bassit El Shaarawy 1 ORCID logo, Walid Anwar 1, Zeinab Ahmed Mahmoud 2, Lina Essam Khedr 1

1 Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2 El-Helal Medical Insurance Hospital, Cairo, Egypt
*Corresponding author: Professor Maha Abdelmoneim Behairy, Email: mahabehairy@med.asu.edu.eg, Mahabehairy80@gmail.com

Abstract

Introduction: Low 25-hydroxyvitamin D (25(OH)D) level in hemodialysis (HD) patients is associated with high bone turnover, secondary hyperparathyroidism, and decreased bone mineral density (BMD).

Objective: To investigate the efficacy of equivalent doses of pulse oral cholecalciferol versus intramuscular (IM) cholecalciferol in correcting serum 25(OH)D levels in HD patients with vitamin D deficiency.

Patients and Methods: In a prospective randomized open-label clinical trial, 80 HD patients with 25(OH)D level <20 ng/mL and serum intact parathyroid hormone (iPTH) level >100 pg/mL were enrolled in the study. Patients were divided into two groups. Group I: 40 HD patients received oral cholecalciferol 25 000 IU weekly for 12 weeks. Group II: 40 HD patients received a single dose of IM cholecalciferol 300 000 IU. Patients were maintained on their regular medications as alfacalcidol or phosphate binders. Serum calcium, phosphorus, 25(OH)D, alkaline phosphatase and iPTH were monitored at 0, 6th, and 12th week of intervention.

Results: Significant increase in serum 25(OH)D level in group II patients who received IM (intramuscular) cholecalciferol, with delta mean a change of vitamin D level was 2.92 ±7.29 ng/mL over three months in comparison to the insignificant change in oral cholecalciferol group. Additionally there was a significant increase in the mean of serum calcium in comparison to oral cholecalciferol group, while we found a statistically significant decrease in alkaline phosphatase level in both groups too (P<0.05). The mean of iPTH levels was reduced significantly with IM cholecalciferol dose (1064.00 ± 787.60 to 609.9 ± 551.41 pg/mL; P<0.05).

Conclusion: Intramuscular cholecalciferol dose is more effective at increasing 25(OH) D levels in dialysis patients than oral supplementation, achieves more increase in serum calcium and reduce iPTH levels. However, the longer duration of treatment is required to achieve recommended levels of vitamin D and suppress high iPTH levels.

Keywords: Cholecalciferol, Hemodialysis, 25 OH vitamin D, Hyperparathyroidism

Implication for health policy/practice/research/medical education:

Low 25(OH) D serum levels is prevalent condition among end-stage renal disease patients on regular hemodialysis associated with increased risk of decreased BMD, risk of bone fractures and increased cardiovascular morbidity. There are various clinical regimens with several forms of vitamin D supplementations among hemodialysis patients with variable outcomes in clinical practice. Cholecalciferol form is apparently cost-effective and safe drug that can be used to correct 25 (OH)D serum level without evident toxicity. This study evaluates the short-term effect of intramuscular cholecalciferol replacement versus weekly oral supplementation on serum vitamin D level and biochemical parameters of bone metabolism in hemodialysis patients with vitamin D deficiency..

Please cite this paper as: Behairy MA, Elsharabasy RM, El Shaarawy AB, Anwar W, Mahmoud ZA, Khedr LE. Oral versus intramuscular cholecalciferol replacement in hemodialysis patients with vitamin D deficiency. J Nephropharmacol. 2022;11(1):e07. DOI: 10.34172/npj.2022.07.


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