TOMAS BERL, M. D.; ARNOLD S. BERNS, M.D.; WILLIAM E. HUFFER, M.D.; KAREN HAMMILL, R.N.; ALLEN C. ALFREY, M.D., F.A.C.P.; CLAUDE D. ARNAUD, M.D., F.A.C.P.; ROBERT W. SCHRIER, M.D., F.A.C.P.
1,25 dihydroxycholecalciferol [1,25(OH)2D3] was studied in a double-blind controlled fashion in patients on chronic dialysis. Serum calcium was unchanged in 16 patients on vitamin D3(D3) (400 to 1200 IU/day). In 15 patients on 1,25(OH)2D3 (0.5 to 1.5 µg/day), serum calcium increased from 9.05 ± .15 to 10.25 ± .20 mg/dl (p < 0.001), returning to 9.37 ± .16 mg/dl (p < 0.001) in the post control period. Patients on D3 showed no reversible decrease in immunoreactive parathyroid hormone levels, but patients on 1,25(OH)2D3 did, from a control of 1077 ± 258 to 595 ± 213 µl equivalents/ml (p < 0.01), and returned to 1165 ± 271 µl equivalents/ml (p < 0.005). Nine of 12 patients on D3 who underwent serial iliac-crest biopsies showed histologic deterioration, and six of seven who received 1,25(OH)2D3 were improved or unchanged (p < 0.025). Bone mineral and calcium decreased in patients on D3 (p < 0.05) but not in those on 1,25(OH)2D3. Hypercalcemia occurred in five of 15 patients. We conclude that 1,25(OH)2D3 has a calcemic effect in chronic dialysis patients, decreases levels of immunoreactive parathyroid hormone, and is associated with histologic improvement in bone disease. Thus, 1,25(OH)2D3 is a valuable adjunct to the management of renal osteodystrophy but requires monitoring of serum calcium to avoid hypercalcemia.
BERL T, BERNS AS, HUFFER WE, HAMMILL K, ALFREY AC, ARNAUD CD, et al. 1,25 Dihydroxycholecalciferol Effects in Chronic Dialysis: A Double-Blind Controlled Study. Ann Intern Med. 1978;88:774–780. doi: 10.7326/0003-4819-88-6-774
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Published: Ann Intern Med. 1978;88(6):774-780.
Nephrology, Renal Replacement Therapy.
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