Vitamin D is a regulator of calcium homeostasis in the body and is important in skeletal development and bone mineralization. Patients with chronic kidney disease can have significant abnormalities of bone and calcium homeostasis and are at increased risk of fracture. The fracture risk for a kidney transplant recipient is four times that of the general population and higher than that for a patient on dialysis.Blood phosphorus and calcium levels can be altered by a hormone called parathyroid hormone (PTH). In chronic kidney disease, PTH production can increase to result in abnormalities of calcium and phosphorus in the blood as well as bone and cardiovascular side effects
Drug |
Dosage Regimen |
Contraindications |
Side Effects |
Drug Interactions |
Doxercalciferol |
Oral:1 to 3 mcg per day in patients not yet on dialysis or 10 to 20 mcg 3 times/week at dialysis; dose adjusted at 8-week intervals based upon the iPTH levels. | High blood calcium; Vitamin D toxicity; high blood phosphorus |
Nausea, vomiting, increase in urine volume, headache, dizziness, constipation |
Cholestyramine, mineral oil-Reduced absorption of doxercalciferol Other Vitamin D supplements – increased risk of vitamin D intoxication, magnesium containing antacids and supplements-Increase the risk of high blood magnesium levels Ketoconazole, erythromycin – decreased conversion of doxercalciferol to active drug Phenobarbital – may need higher doses of doxercalciferol |
Calcitriol |
Oral: 0.25-2 mcg/day or every other day; increases should be made at 4 to 8 week intervals |
High blood calcium; vitamin D intoxication, malabsorption syndrome; allergic reaction |
High blood calcium, constipation, headache, high or low blood pressure, increased production of urine volume, seizures |
Decreased effect/absorption: Cholestyramine, colestipol |
Paricalcitol |
Oral: 1 to 2 mcg daily or 2 to 4 mcg three times weekly IV: 0.04-0.1 mcg/kg given 3 times weekly during dialysis |
Vitamin D toxicity; high blood calcium; hypersensitivity to any component of the drug |
Nausea, vomiting, swelling, chills, fever, lightheadedness |
Vitamin D-increased risk of vitamin D intoxication; related drugs should not be taken while taking this drug. |
