vitamin-d-2 and Anemia

Studies in rats with renal ablation indicate that anemia lessens, whereas its vigorous correction with recombinant human erythropoietin (r-HuEPO) worsens systemic and glomerular hypertension, factors known to promote progression of chronic renal failure (CRF). However, in human studies, use of r-HuEPO in predialysis patients has not been associated with worsening renal function, provided blood pressure control is achieved. Histological evidence of bone disease is common in early renal failure, and deficits in calcitriol synthesis seem to be an important factor in the pathogenesis of secondary hyperparathyroidism (HPTH) in early CRF. Reports to data, on the use of low dose active vitamin D metabolites in predialysis patients, indicate either a reversible decline or no decline in renal function. Adynamic bone disease, however, may ensure during such therapy if excessive reductions in serum intact parathyroid hormone concentrations occur. Recent data suggest that chronic metabolic acidosis decreases albumin synthesis, increases muscle proteolysis, and induces negative nitrogen balance in patients with CRF. Despite these experimental data, the clinical relevance of correction of metabolic acidosis in end-stage renal disease (ESRD) is still not defined. Even though therapy of metabolic acidosis in the adult patient with CRF remains conjectural at this time, reports indicate that its correction might lead to healing of osteomalacia and osteopenia, and possibly may decrease protein degradation and improve growth in children with CRF.

Topics: Acidosis; Adult; Anemia; Animals; Calcitriol; Calcium Compounds; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Ergocalciferols; Erythropoietin; Humans; Kidney Failure, Chronic; Rats; Recombinant Proteins; Renal Dialysis

Vitamin D insufficiency is related to erythropoietin resistance in chronic kidney disease (CKD). This study was conducted to evaluate the effect of ergocalciferol on the dose of erythrocyte-stimulating agent (ESA) administered to children with CKD stage 5 and vitamin D insufficiency.. Twenty patients aged <18 years with CKD stages 5 or 5D and vitamin D insufficiency were divided into two groups. During the 12-week study, ten patients received oral ergocalciferol (treatment) whereas the other ten patients did not (control). The ESA dosage was recorded monthly.. There were no significant differences in demographic data, ESA dosages, and laboratory data, including corrected calcium, phosphorus, parathyroid hormone, hemoglobin, ferritin, 25-hydroxyvitamin D (25D), and transferrin saturation levels, between the two groups at baseline. At the completion of the study, serum 25D levels in the treatment group were significantly increased from baseline (p = 0.02) and were significantly higher than the serum 25D levels in the controls (p < 0.005). The ESA dosage in the treatment group was significantly decreased when compared to baseline (p = 0.04).. Vitamin D deficiency should be routinely detected and treated. Our results show that the administration of ergocalciferol in conjunction with 1,25-dihydroxyvitamin D3 reduced the dose of ESA required to treat children with CKD stages 5 and 5D and may decrease erythropoietin resistance.

Topics: Administration, Oral; Adolescent; Analysis of Variance; Anemia; Biomarkers; Child; Child, Preschool; Drug Resistance; Epoetin Alfa; Ergocalciferols; Erythropoietin; Female; Hematinics; Humans; Male; Prospective Studies; Recombinant Proteins; Renal Insufficiency, Chronic; Severity of Illness Index; Thailand; Time Factors; Treatment Outcome; Vitamin D; Vitamin D Deficiency

To investigate the effects of Vitamin D Analogs, paricalcitol and alphacalcidol, on hemoglobin levels and erythropoietin-stimulating agents' dosage in hemodialysis patients with chronic renal failure. A total of 310 patients under hemodialysis treatment for chronic renal failure were included in this retrospective multicenter study. Data on serum parathormone and hemoglobin levels, erythropoietin-stimulating agents' doses, C-reactive protein, calcium and phosphate levels were collected from medical records to comparatively evaluate paricalcitol, alphacalcidol and no treatment groups. Apart from significantly higher levels for hematocrit in patients treated with paricalcitol compared to pre-treatment values (32.3(3.8) vs. 34.1(3.1) p=0.007), pre-treatment and post-treatment values for biochemical parameters were similar in paricalcitol and alphacalcidol groups including ESA dose. A significant increase in parathormone levels (p=0.000 for each) while a significant decrease in calcium (p=0.003 and 0.040, respectively), Hb (p=0.001 and 0.009, respectively) and hematocrit (p=0.001 and 0.021, respectively) levels were determined in paricalcitol and alphacalcidol treated patients compared with untreated patients. Also, phosphate levels in alphacalcidol treated patients were significantly higher (p=0.018) than untreated patients. Our findings revealed insufficient suppression of parathormone levels and there of lower hemoglobin and hematocrit levels, but similar ESA dosage among CRF patients treated with Vitamin D analogs compared with untreated patients.

Topics: Aged; Anemia; Ergocalciferols; Female; Hematinics; Hemoglobins; Humans; Hydroxycholecalciferols; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Renal Dialysis; Retrospective Studies

Topics: Anemia; Ergocalciferols; Female; Hematopoiesis; Humans; Infant; Male; Primary Myelofibrosis; Rickets

Topics: Anemia; Animals; Ascorbic Acid; Breast Feeding; Child, Preschool; Environment; Ergocalciferols; Female; Fish Oils; Food Additives; Housing; Humans; Hypercalcemia; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Milk; Rickets; Scotland; Social Conditions; United Kingdom; Vitamin D; Vitamin D Deficiency