Vitamin D Supplementation in Patients on Alfacalcidol

Clinical Guidelines and Recommendations

The National Kidney Foundation recommends measuring 25-hydroxyvitamin D levels in patients with chronic kidney disease (CKD) already on active vitamin D therapy (including alfacalcidol) and supplementing if deficient, with a strength of evidence rated as moderate 3
The National Kidney Foundation suggests that patients with CKD and vitamin D deficiency (25(OH)D <30 ng/mL) should receive supplementation with ergocalciferol or cholecalciferol, with a strength of evidence rated as strong 3
The American Journal of Kidney Diseases recommends standard supplementation doses (800-1,000 IU daily) for patients with vitamin D deficiency, which are generally safe when combined with alfacalcidol, with a strength of evidence rated as moderate 5

The National Kidney Foundation recommends monitoring serum calcium and phosphorus at least every 3 months during combined therapy, with a strength of evidence rated as strong 3
The National Kidney Foundation advises that if serum corrected total calcium exceeds 10.2 mg/dL, all forms of vitamin D therapy including native vitamin D supplements should be discontinued, with a strength of evidence rated as strong 3

The National Kidney Foundation suggests that patients with X-linked hypophosphataemia (XLH) should maintain normal nutritional vitamin D status while on alfacalcidol therapy, with a strength of evidence rated as moderate 1, 2, 6