Daily Variability in Mineral Metabolites in CKD and Effects of Dietary Calcium and Calcitriol
Clinical Journal of the American Society of Nephrology, 05/09/2012
Isakova T et al. – Short-term treatment with calcitriol and dietary calcium supplementation normalizes the parathyroid and calcemic postprandial responses in patients with CKD, in whom the diurnal rhythms of mineral metabolites are preserved.
Twelve CKD patients received calcitriol (0.25 μg daily for 1 week) with hourly assessments of mineral metabolites made throughout the day and in the context of standardized meals before and after treatment.
Calcium content (250 versus 500 mg) in the breakfasts constituted the dietary calcium intervention.
Twelve healthy volunteers were used as controls.
At baseline, compared with controls, fasting CKD subjects had higher parathyroid hormone and fibroblast growth factor 23 levels and greater fractional excretion of phosphate.
After breakfast, urinary calcium excretion increased and parathyroid hormone levels dipped transiently in both groups, but they rose soon thereafter, reaching higher peaks in CKD.
Calcitriol decreased fasting parathyroid hormone levels, and when combined with dietary calcium load, it normalized the postprandial parathyroid and calcemic responses.
Daily variability in mineral metabolites was preserved in CKD before and after calcitriol.
Fibroblast growth factor 23 levels increased after calcitriol, although the response was heterogeneous.
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