FP444ATTENUATION OF SECONDARY HYPERPARATHYROIDISM PROGRESSION IN STAGE 3-4 CKD REQUIRES A SERUM TOTAL 25-HYDROXYVITAMIN D TARGET ABOVE 50 NG/ML
Bibliographic record
Abstract
INTRODUCTION: Clinical practice guidelines for CKD target 30 ng/mL for serum total 25-hydroxyvitamin D (25D). However, recent evidence suggests that higher 25D levels are required to attenuate the progression of secondary hyperparathyroidism (SHPT) in patients with stage 3-4 disease. This secondary analysis of two randomized clinical trials (RCTs) with extended-release calcifediol (ERC) explored the minimum mean serum level of 25D required to attenuate SHPT progression. METHODS: Two identical RCTs were conducted in 429 adult subjects with stage 3-4 CKD, SHPT (≥85 and <500 pg/mL) and vitamin D insufficiency (serum 25D ≥10 and < 30 ng/mL). Subjects in each study were randomized 2:1 in a double-blinded fashion to receive ERC (30 or 60 mcg/day) or placebo for 26 weeks. Data from 356 per-protocol subjects (irrespective of treatment assignment) were ranked by serum total 25D value at the end of treatment (EOT) and divided into quintiles. SHPT progression, defined as an increase in EOT intact parathyroid hormone (iPTH) >10% from pre-treatment baseline, was calculated for each quintile. RESULTS: Mean (SE) plasma iPTH levels at baseline and EOT are summarized in the table below by post-treatment serum 25D quintile, along with the percentage of subjects experiencing SHPT progression. aReduced from Quintile 1, p<0.05 More than one-third of subjects receiving inadequate vitamin D replacement therapy (Quintiles 1 and 2) experienced SHPT progression. Mean iPTH and the percentage of subjects with SHPT progression were reduced only when mean serum total 25D was increased with ERC treatment to at least 51 ng/mL. CONCLUSIONS: Pooled data from two identical prospective RCTs with ERC support aggressive vitamin D repletion therapy to attenuate SHPT progression and a revised serum 25D target of at least 51 ng/mL in stage 3-4 CKD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".