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Native vs. active vitamin D in children with chronic kidney disease: a cross-over study

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Abstract

Background

The rationale for the prescription of vitamin D analogues in patients with chronic kidney disease (CKD) is still a matter of debate. We aimed to compare native vs. active forms of vitamin D on pre-dialysis children with CKD and evaluate effects on calcium (Ca), phosphorus (P), and parathyroid hormone (PTH).

Methods

Thirty children with pre-dialysis CKD were enrolled in a prospective cross-over study. Patients were randomly classified into two groups. Group A received native cholecalciferol while group B received alfacalcidol for 3 months. After 1 month (washout period), patients were switched to receive the opposite form for another 3 months. Serum Ca, P, alkaline phosphatase (ALP), PTH, and 25(OH)D3 were measured at study start (BL-1), end of first period (FU-1), before second period (BL-2), and after second period (FU-2).

Results

There was significant increase in levels of 25(OH)D3 after administration of either native or active vitamin D in the first period in both groups (p < 0.001 and < 0.001, respectively) and also in the second period for both groups (p = 0.02 and < 0.001, respectively). There was no significant difference between both groups regarding changes in serum Ca (1st period; p = 0.770 and 2nd period; p = 0.412), serum P (1st period; p = 0.835, 2nd period; p = 0.052), and serum PTH (1st period; p = 0.250, 2nd period; p = 0.539).

Conclusion

Alfacalcidol and native vitamin D3 were equally effective in decreasing PTH levels and increasing serum 25(OH)D3 in pre-dialysis CKD patients. There was no significant difference between the two forms regarding changes in serum Ca or P.

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Authors and Affiliations

  1. Pediatric Nephrology Department, Cairo University, 5 El-Lithy Street El-Maadi El-Gedida, Cairo, 11435, Egypt

    Happy Sawires, Fatina Fadel, Ahmed Hussein & Rasha Helmy

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  1. Happy Sawires
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  2. Fatina Fadel
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  3. Ahmed Hussein
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Corresponding author

Correspondence to Happy Sawires.

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The study was conducted in accordance with the Declaration of Helsinki. An informed written consent was obtained from patients’ caregivers and the study was approved by the local ethical committee. The research does not include animals. The research includes clinical trials on human subjects.

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The authors declare that they have no conflict of interest.

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Sawires, H., Fadel, F., Hussein, A. et al. Native vs. active vitamin D in children with chronic kidney disease: a cross-over study. Pediatr Nephrol 36, 443–450 (2021). https://doi.org/10.1007/s00467-020-04721-1

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