Which medications in the drug class Vitamin D Analogues are used in the treatment of Chronic Kidney Disease?

Updated: Oct 26, 2020
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Vitamin D Analogues

Vitamin D analogues are recommended in patients with CKD stages 3-5 who are not on dialysis and in whom the serum parathyroid hormone (PTH) level is elevated or has been persistently rising. Vitamin D increases the absorption of calcium in the intestines and helps to prevent secretion of calcium in the kidneys. By increasing calcium levels in serum, it helps to decrease phosphate and PTH levels, as well as bone resorption.

Calcitriol (Rocaltrol, Calcijex, Vectical)

Calcitriol (1,25-dihydroxycholecalciferol or 1,25-dihydroxyvitamin D3), the potent active metabolite of vitamin D, can be used to suppress PTH production and secretion in secondary hyperparathyroidism. In addition, calcitriol can alleviate hypocalcemia in CKD by increasing intestinal calcium absorption and helping to prevent secretion of calcium in the kidneys.

Doxercalciferol (Hectorol)

Doxercalciferol is a vitamin D analogue (1-alpha-hydroxyergocalciferol) that does not require activation by the kidneys. It is metabolized to the active form of vitamin D. Doxercalciferol is indicated for the treatment of secondary hyperparathyroidism in patients with CKD.

Paricalcitol (Zemplar)

Paricalcitol is a synthetic vitamin D analogue that binds and activates vitamin D receptors in the kidneys, parathyroid glands, intestines, and bones. It is used for the prevention and treatment of secondary hyperparathyroidism associated with CKD stages 3-4 and stage 5 patients on hemodialysis or peritoneal dialysis. It reduces PTH levels, improves calcium and phosphorus homeostasis, and stimulates bone mineralization.

Calcifediol (Rayaldee)

Extended-release formulation of calcifediol (25-hydroxyvitamin D3), a prohormone of the active form of vitamin D3. Calcifediol is converted to calcitriol by CYP27B1, also called 1-alpha hydroxylase, primarily in the kidney. Calcitriol binds to the vitamin D receptor in target tissues and activates vitamin D responsive pathways that result in increased intestinal absorption of calcium and phosphorus and reduced parathyroid hormone synthesis. It is indicated for secondary hyperparathyroidism associated with vitamin D insufficiency in patients with stage 3 or 4 chronic kidney disease (CKD) and serum total 25-hydroxyvitamin D levels


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