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Metabolic effects of cholecalciferol supplementation in patients with calcium nephrolithiasis and vitamin D deficiency

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Abstract

Introduction

In this paper, we investigated whether cholecalciferol supplementation may increase the risk of stone recurrence in patients with calcium nephrolithiasis and Vitamin D deficiency.

Methods

Thirty-three stone formers (56 ± 17 years old, 12 males) with 25(OH)D < 20 ng/mL were considered. Calcium excretion and urine supersaturation with calcium oxalate (ßCaOx) and brushite (ßbsh) were evaluated, both before and after cholecalciferol supplementation. Values of ß > 1 mean supersaturation. Cholecalciferol was prescribed as oral bolus of 100,000–200,000 IU, followed by weekly (5000–10,000 IU) or monthly (25,000–50,000 IU) doses. Calcium intake varied between 800 and 1000 mg/day.

In urine, total nitrogen (TNE) was taken as an index of protein intake, sodium as a marker of dietary intake, and net acid excretion (NAE) as an index of acid–base balance.

Results

TNE, sodium, and NAE did not change during the study (p = ns). Compared to baseline values, after cholecalciferol, both serum calcium and phosphate did not vary (p = ns); 25(OH)D increased from 11.8 ± 5.5 to 40.2 ± 12.2 ng/mL (p < 0.01); 1.25(OH)2D increased from 41.6 ± 17.6 to 54 ± 16 pg/mL (p < 0.01); PTH decreased from 75 ± 27.2 to 56.7 ± 21.1 pg/mL (p < 0.01); urinary calcium increased from 2.7 ± 1.5 to 3.6 ± 1.6 mg/Kg b.w. (p < 0.01); ßbsh increased from 0.9 ± 0.7 to 1.3 ± 1.3 (p = 0.02); whereas ßCaOx varied but not significantly. Before cholecalciferol supplementation, 6/33 patients were hypercalciuric (i.e., urine Ca ≥ 4 mg/Kg b.w.) and increased to 13/33 after cholecalciferol supplementation (pX2 = 0.03).

Conclusions

Cholecalciferol supplementation may increase calcium excretion, or reveal an underlying condition of absorptive hypercalciuria. This may increase both urine supersaturation with calcium salts and stone-forming risk.

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Authors and Affiliations

  1. S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino, Largo Turati, 62, 10128, Turin, Italy

    Corrado Vitale, Francesca Bermond, Laura Fabbrini & Alberto Tricerri

  2. Fondazione Scientifica Mauriziana ONLUS, Largo Turati 62, 10128, Turin, Italy

    Martino Marangella

Authors
  1. Corrado Vitale
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  2. Martino Marangella
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  3. Francesca Bermond
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  4. Laura Fabbrini
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  5. Alberto Tricerri
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Contributions

CV: project development, data analysis, manuscript writing; MM: data analysis, manuscript editing; FB: data management; LF: data collection; AT: data collection.

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Correspondence to Corrado Vitale.

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Vitale, C., Marangella, M., Bermond, F. et al. Metabolic effects of cholecalciferol supplementation in patients with calcium nephrolithiasis and vitamin D deficiency. World J Urol 39, 597–603 (2021). https://doi.org/10.1007/s00345-020-03222-y

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  • DOI: https://doi.org/10.1007/s00345-020-03222-y

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