Chronic renal failure and vitamin D metabolites: a status report

Seventeen undialysed adult patients with chronic renal failure took part in a controlled study of the effects of 1,25(OH)2D3 and D3. After a 6-month observation period the patients were allocated at random to 2 groups for 6 months of treatment with either 1,25(OH)2D3 (mean dose 0.5 micrograms daily) or D3 (dose 100 micrograms daily). Treatment was then discontinued and the patients were studied for a further 3 months. The patients as a group initially had a moderate renal osteodystrophy. During treatment serum iPTH decreased in both groups but most markedly in the 1,25(OH)2D3 group in which the iPTH values became normal. Serum creatinine increased during treatment in both groups, in the group receiving 1,25(OH)2D3 this was coupled with an increase in serum calcium to within the normal range. Our data demonstrate that 1,25(OH)2D3 treatment in patients with chronic renal failure leads to a further reduction in renal function, which may be partially reversible. Physicians should therefore be reluctant to give vitamin D analogues to patients with chronic renal failure unless they have severe symptomatic renal osteodystrophy.