Clinical Uses of 1-alpha-hydroxycholecalciferol

Marc      Vervloet

Abstract

Alfacalcidol is a widely used vitamin D compound, especially in clinical nephrology because it does not require enzymatic activation by the kidneys. For that reason it has been used for decades to treat abnormalities in bone and mineral balance that arise in chronic kidney disease. In this review an overview is provided of available experimental and clinical data that form the basis of its widespread use. Supported by studies on cell lines and animal models, clinical studies have firmly established beneficial effects of alfacalcidol on chronic-kidney disease (CKD-) related bone disease and secondary hyperparathyroidism. Its effects on muscle structure and function are not unambiguous. Neither experimental nor clinical data suggest beneficial effects of alfacalcidol on indicators of cardiovascular disease, including cardiovascular calcification, left ventricular mass function or hypertension. Suggestions of improved mortality in dialysis patients treated with alfacalcidol are based on observational cohort analyses. Integrating all available data leads the conclusion that alfacalcidol is a justifiable compound to prescribe to CKD patients with established bone disease or hyperparathyroidism. Monitoring of calcium and phosphorus levels after its initiation is required and dose adaptations should be made accordingly.

Keywords: Alfacalcidol, bone mineral density, chronic kidney disease, cardiovascular disease, CKD-MBD, secondary hyperparathyroidism, vitamin D.

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