Contributions
Abstract: P1276
Type: Poster Sessions
Abstract Category: Therapy - Others
Background: Vitamin D is implicated in the pathogenesis of multiple sclerosis (MS) and increasing attention is paid to its use as add-on therapy to established disease-modifying therapies. While cholecalciferol supplementation was mostly tested in a daily dose of 2000-10.000 IU and for up to two years in clinical trials and appeared safe, there is limited knowledge about complications due to chronic ultra high-dose intake.
Methods: Case report of severe kidney failure caused by ultra high-dose vitamin D intake.
Results: A male patient was diagnosed primary progressive MS at the age of 52 back in 2015 following progressive motor dysfunction and visual disturbances. He returned to our outpatient clinic one year later with reduced general condition and fatigability. Laboratory testing showed elevated creatinine levels (6.8 mg/dl) and reduced glomerular filtration rate (GFR) of 8.25 ml/min. Calcium levels were elevated (3.29 mmol/l) and haemoglobin reduced (8 g/dl). He admitted an uncontrolled daily intake of 50.000-100.000 IU of cholecalciferol over several months after reports about a potential beneficial role of ultra high-dose vitamin D intake came to his attention. We diagnosed acute kidney failure but pharmaceutical measures to reduce calcium levels failed. Repeat haemodialysis was mandatory, and kidney function improved over time, yet graded as G4A2 in 2/2018. We started treatment with ocrelizumab at an unchanged EDSS of 6 in 12/2017 following nephrological consultation.
Conclusion: Uncontrolled intake of ultra high-dose vitamin D can cause life-threatening complications including acute kidney dysfunction. Our case reinforces the need of close monitoring by the physician and attention to the local recommendation of daily cholecalciferol supplementation (mostly 2000.5000 IU/day), as well as further elucidation of the potential beneficial effects of regular vitamin D intake in MS.
Disclosure: JF received travel funding from Roche. HS: nothing to disclose. CH: nothing to disclose. ABK: nothing to disclose. JS received speakers honoraria and served on advisory board of following companies: Bayer, Biogen, Merck, Sanofi, Novartis, Roche, Medday, Teva-Ratiopharm.
Abstract: P1276
Type: Poster Sessions
Abstract Category: Therapy - Others
Background: Vitamin D is implicated in the pathogenesis of multiple sclerosis (MS) and increasing attention is paid to its use as add-on therapy to established disease-modifying therapies. While cholecalciferol supplementation was mostly tested in a daily dose of 2000-10.000 IU and for up to two years in clinical trials and appeared safe, there is limited knowledge about complications due to chronic ultra high-dose intake.
Methods: Case report of severe kidney failure caused by ultra high-dose vitamin D intake.
Results: A male patient was diagnosed primary progressive MS at the age of 52 back in 2015 following progressive motor dysfunction and visual disturbances. He returned to our outpatient clinic one year later with reduced general condition and fatigability. Laboratory testing showed elevated creatinine levels (6.8 mg/dl) and reduced glomerular filtration rate (GFR) of 8.25 ml/min. Calcium levels were elevated (3.29 mmol/l) and haemoglobin reduced (8 g/dl). He admitted an uncontrolled daily intake of 50.000-100.000 IU of cholecalciferol over several months after reports about a potential beneficial role of ultra high-dose vitamin D intake came to his attention. We diagnosed acute kidney failure but pharmaceutical measures to reduce calcium levels failed. Repeat haemodialysis was mandatory, and kidney function improved over time, yet graded as G4A2 in 2/2018. We started treatment with ocrelizumab at an unchanged EDSS of 6 in 12/2017 following nephrological consultation.
Conclusion: Uncontrolled intake of ultra high-dose vitamin D can cause life-threatening complications including acute kidney dysfunction. Our case reinforces the need of close monitoring by the physician and attention to the local recommendation of daily cholecalciferol supplementation (mostly 2000.5000 IU/day), as well as further elucidation of the potential beneficial effects of regular vitamin D intake in MS.
Disclosure: JF received travel funding from Roche. HS: nothing to disclose. CH: nothing to disclose. ABK: nothing to disclose. JS received speakers honoraria and served on advisory board of following companies: Bayer, Biogen, Merck, Sanofi, Novartis, Roche, Medday, Teva-Ratiopharm.