Vitamin D supplementation and recombinant human erythropoietin utilization in vitamin D-deficient hemodialysis...

We sought to examine the impact of ergocalciferol (ERGO) on recombinant human erythropoietin (EPO) use in a cohort of 25-OH vitamin D (25-D)-deficient hemodialysis (HD) patients.

Baseline 25-D levels were obtained for all patients who received HD >6 months in our unit. Patients with levels between 10 and 30 ng/mL received ERGO 50,000 IU x 4 doses and patients with levels <10 ng/mL received 50,000 IU x 6 doses over a 4-month period. Monthly dose of EPO was recorded at baseline and after ERGO supplementation.

Baseline 25-D levels were <30 ng/mL in 89% of tested patients. Eighty-one patients were included in this study. Mean baseline 25-D level was 15.3 ± 7.1 ng/mL and increased to 28.5 ± 8.6 ng/mL after ERGO (p<0.0001), and median baseline EPO dose was 21,933 U/month (interquartile range [IQR] 13,867-35,967) and decreased to 18,400 U/month (IQR 11,050-33,000) after ERGO (p=0.17). Forty-six patients (57%) required less EPO after ERGO compared with baseline: 15,450 U/month (IQR 10,056-23,575) vs. 26,242 U/month (IQR 15,717-40,167), respectively (p<0.0001). Thirty-five patients (43%) required a higher dose of EPO after ERGO, 26,350 U/month (IQR 15,875-46,075) vs. 17,667 U/month (IQR 12,021-23,392), respectively (p=0.016). Mean age, sex, vintage, diabetes status, race and 25-D levels did not differ in these 2 groups of patients, either at baseline or after ERGO. Monthly hemoglobin, iron saturation, albumin, intact parathyroid hormone, calcium and phosphorus were unchanged after ERGO in these 2 groups.

ERGO use in 25-D-deficient HD patients may lessen the need for EPO. We recommend more aggressive supplementation with ERGO in future studies to achieve levels >30 ng/mL.