Daniel W. Coyne, MD
Potential Financial Conflicts of Interest:Consultancies: Abbott Laboratories, INEOS. Honoraria: Abbott Laboratories. Grants received: Abbott Laboratories, Amgen.
Coyne D.; Vitamin D Compounds in Chronic Kidney Disease. Ann Intern Med. 2008;148:969-970. doi: 10.7326/0003-4819-148-12-200806170-00013
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Published: Ann Intern Med. 2008;148(12):969-970.
TO THE EDITOR:
The meta-analysis by Palmer and colleagues (1) concludes that vitamin D compounds “do not consistently reduce PTH levels.” Parathyroid hormone suppression by “established vitamin D” is based on only 6 studies encompassing 187 patients. Of the 5 studies I could locate, none seemed to titrate vitamin D to achieve PTH level suppression or to have PTH level suppression as a primary goal. Active vitamin D treatment did cause significant improvements in the 3 studies examining bone histology and the 1 study examining bone mineral density. Meta-analyses must carefully assess the goals of trials from differing eras. Four of these studies were done in the 1980s and, therefore, must have used C-terminal PTH assays, which detect PTH fragments that accumulate in renal failure.
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