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Conversion from Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis.

Authors
  • Thadhani, Ravi I1
  • Rosen, Sophia2
  • Ofsthun, Norma J2
  • Usvyat, Len A3
  • Dalrymple, Lorien S2
  • Maddux, Franklin W4
  • Hymes, Jeffrey L2
  • 1 Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.
  • 2 Fresenius Medical Care North America, Waltham, Massachusetts; and.
  • 3 Fresenius Medical Care North America, Waltham, Massachusetts; and [email protected]
  • 4 Fresenius Medical Care AG & Co., KGaA, Bad Homburg, Germany. , (Germany)
Type
Published Article
Journal
Clinical Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Mar 06, 2020
Volume
15
Issue
3
Pages
384–391
Identifiers
DOI: 10.2215/CJN.07960719
PMID: 32111702
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In the United States, intravenous vitamin D analogs are the first-line therapy for management of secondary hyperparathyroidism in hemodialysis patients. Outside the United States, oral calcitriol (1,25-dihydroxyvitamin D3) is routinely used. We examined standard laboratory parameters of patients on in-center hemodialysis receiving intravenous vitamin D who switched to oral calcitriol. We conducted a retrospective cohort study of adult patients treated within Fresenius Kidney Care clinics. During a 6-month period (December 2013 to May 2014), we identified patients on an intravenous vitamin D analog (doxercalciferol or paricalcitol) who switched to oral calcitriol and matched them to patients receiving an intravenous vitamin D analog. Mean serum calcium, phosphate, and intact parathyroid hormone (iPTH) concentrations were examined for up to 12 months of follow-up. We used Poisson and Cox proportional hazards regression models to examine hospitalization and survival rates. The primary analysis was conducted as intention-to-treat; secondary analyses included an as-treated evaluation. A total of 2280 patients who switched to oral calcitriol were matched to 2280 patients receiving intravenous vitamin D. Compared with patients on intravenous vitamin D, mean calcium and phosphate levels in the oral calcitriol group were lower after the change to oral calcitriol. In contrast, iPTH levels were higher in the oral calcitriol group. At 12 months, the percentage of patients with composite laboratories in target range (calcium <10 mg/dl, phosphate 3.0-5.5 mg/dl, and iPTH 150-600 pg/ml) were comparable between groups (45% versus 45%; P=0.96). Hospital admissions, length of hospital stay, and survival were comparable between groups. An as-treated analysis and excluding those receiving cinacalcet did not reveal significant between-group differences. Among patients receiving in-center hemodialysis who were switched to oral calcitriol versus those on an intravenous vitamin D analog, the aggregate of all mineral and bone laboratory parameters in range was largely similar between groups. Copyright © 2020 by the American Society of Nephrology.

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