Parameters of calcium and phosphate homeostasis in patients with predialysis CKD in response to 150 000 IU cholecalciferol treatment

Artem Zhukov; Axenia Bondarenko; Alexandra Povaliaeva; Zamira Zuraeva; Natalia Trubitsyna; Larisa Nikankina; Minara Shamkhalova; Ekaterina Pigarova; Liudmila Rozhinskaya; Natalia Mokrysheva

doi:10.1530/endoabs.93.OC56

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Endocrine Abstracts (2023) 93 OC56 | DOI: 10.1530/endoabs.93.OC56

EYES2023 ESE Young Endocrinologists and Scientists (EYES) 2023 Oral communication 9: Calcium and Bone (4 abstracts)

Parameters of calcium and phosphate homeostasis in patients with predialysis CKD in response to 150 000 IU cholecalciferol treatment

Artem Zhukov ¹ , Axenia Bondarenko ² , Alexandra Povaliaeva ² , Zamira Zuraeva ² , Natalia Trubitsyna ² , Larisa Nikankina ² , Minara Shamkhalova ² , Ekaterina Pigarova ² , Liudmila Rozhinskaya ² & Natalia Mokrysheva ²

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¹Endocrinology Research Centre, Department of Neuroendocrinology and Bone Diseases, Moscow, Russian Federation; ²Endocrinology Research Centre.

Objectives: to study the response of calcium and phosphate homeostasis parameters to the cholecalciferol loading dose in patients with predialysis chronic kidney disease (CKD).

Methods: We examined 17 patients with stage 3 CKD (CKD3) and 9 patients with stages 4–5 CKD (CKD4-5) without previously known disorders of mineral metabolism and intake of interfering drugs during last 3 months. The assessments included serum 25-hydroxyvitamin D (25(OH)D), free 25(OH)D, vitamin D-binding protein (DBP), parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23) and biochemical parameters before and 7 days after oral administration of 150 000 IU cholecalciferol.

Results: The groups did not differ significantly in age, sex, BMI, duration of CKD and baseline laboratory parameters: 25(OH)D 10.3[9.8;24.3] vs. 16.0[8.8;20.7] ng/ml (RI 30–60), albumin-adjusted calcium 2.30[2.29;2.36] vs. 2.27[2.24;2.31] mmol/l (RI 2.15–2.55), phosphorus 1.31[1.09;1.50] vs. 1.49[1.22;1.51] mmol/l (RI 0.74–1.52), PTH 71.9[50.4;115.2] vs. 92.4[78.5;117.3] pg/ml (RI 15–65), magnesium 0.89[0.82;0.97] vs. 0.81[0.79;0.86] mmol/l (RI 0.7–1.05), FGF23 1.20[0.86;2.14] vs. 2.24[1.61;3.30] pmol/l (RI NA), DBP 243[201;256] vs. 256[206;266] mg/l (RI 176–623), free 25(OH)D 4.23[3.84;5.25] vs. 4.91[3.63;5.66] pg/ml (RI 2.4–35) in CKD3 and CKD4-5, respectively (P>0.05). By day 7 we observed an increase in 25(OH)D (32.4[23.5; 42.5] ng/ml, P<0.001) and free 25(OH)D (6.52[5.96; 7.87] pg/ml, P<0.001) and a decrease in PTH (63.4[48.6;79.3] pg/ml, P=0.03) in CKD3 and increase in 25(OH)D (28.6[17.8;29.8] ng/ml, P=0.008), free 25(OH)D (6.77[5.75;7.41] pg/ml, P=0.004), FGF23 (4.86[3.00;5.74] pmol/l, P=0.008) in CKD4-5; the changes in the rest of the parameters were not statistically significant. The levels of PTH and FGF23 by day 7 were higher in CKD4-5 than in CKD3 (P=0.045 and P=0.009, respectively).

Conclusions: A bolus 150 000 IU cholecalciferol treatment results in a decrease in PTH in CKD3 and an increase in FGF23 in CKD4-5, despite an equivalent increase in total and free 25(OH)D.

This work was supported by the Russian Science Foundation (grant number 19-15-00243-P).