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The efficacy of routine cholecalciferol supplementation in haemodialysis patients : an investigation into the effects of improved serum 25(OH)D on mineral bone markers, anaemia, and health-related quality of life
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Huish, S. A. (2021) The efficacy of routine cholecalciferol supplementation in haemodialysis patients : an investigation into the effects of improved serum 25(OH)D on mineral bone markers, anaemia, and health-related quality of life. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3710606~S15
Abstract
Low 1,25(OH)2D in end stage renal disease (ESRD) is considered a consequence of reduced 1α-hydroxylase rather than 25(OH)D deficiency. University Hospital Coventry and Warwickshire introduced cholecalciferol supplementation for all 350 haemodialysis patients in 2014. This project aimed to determine if cholecalciferol safely and effectively improves serum 25(OH)D, and investigate effects on bone markers, anaemia and health-related quality of life (HRQOL).
Routine biochemical data (serum corrected calcium, phosphate, PTH, ferritin, and haemoglobin) and erythropoietin dose, was collected for 12 months pre, and 15 months post, introduction of cholecalciferol. A 3-month repletion phase was assumed. Two 12-month observation periods were compared, T-12 to T-1 and T4- T15. Two sub-studies were undertaken; blood samples were taken at baseline (T0) and 12 months (T12) for the measurement of vitamin D metabolites and hepcidin (n=81), SF36 and EQ-5D questionnaires were completed at baseline, 4, 8 and 12 months (n=141).
Mean serum 25(OH)D increased from 27.4±25.3nmol/L (T0) to 120.6±27.1nmol/L (T15) (P<0.001), and 1,25(OH)2D3 increased from 45.3±25.7pmol/L (T0) to 106.6±44.0pmol/L (T12), (P<0.001). Mean corrected calcium and phosphate increased from 2.29±0.13mmol/L and 1.49±0.36mmol/L pre, to 2.35±0.13mmol/L (P<0.001) and 1.54±0.41 (P=0.045) post, respectively. Mean PTH was 41.2±38.7pmol/L pre, and 37.2±35.3pmol/L post (P=0.12). Mean monthly EPO dose was 141.30±127.16µg pre and 139.34±139.58µg, post (P=0.03). Mean ferritin and haemoglobin were 380.7±148.8µg/L and 106.2±9.7g/L pre and 399.2±156.2µg/L (P = 0.35) and 105.0±10.2g/L (P = 0.004) post, respectively. Mean serum hepcidin was 110.7±71.0ng/mL (T0) and 109.8±61.0 ng/mL (T12) (P = 0.73). SF-36 physical and mental component summary scores were 33.1 (27.6-39.9) and 48.6 (38.8-55.1) (T0) and 33.0 (27.5-40.2), (P=0.70) and 48.0 (40.4-56.6), (P=0.84) (T12), respectively. EQ-5D value index scores were 0.64 (0.39-0.75) (T0) and 0.64 (0.38-0.77) (T12), (P=0.91).
In conclusion, 1,25(OH)2D3 deficiency in ESRD is partly a consequence of 25(OH)D deficiency. Routine cholecalciferol is safe and effective, and may offer benefits above active analogue monotherapy.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RC Internal medicine | ||||
Library of Congress Subject Headings (LCSH): | Chronic renal failure -- Treatment, Chronic renal failure -- Patients, Hemodialysis -- Patients, Cholecalciferol | ||||
Official Date: | March 2021 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Bland, Rosemary ; Dunn, Janet ; Hewison, Martin | ||||
Sponsors: | British Renal Society ; British Kidney Patient Association ; Internis Pharmaceuticals Ltd. | ||||
Format of File: | |||||
Extent: | xiv, 252 leaves : illustrations (some colour) | ||||
Language: | eng |
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