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July 26, 1976

Calcifediol in Chronic Renal Insufficiency-Reply

Author Affiliations

Washington University School of Medicine St Louis

JAMA. 1976;236(4):347. doi:10.1001/jama.1976.03270040013016

We appreciate the comments of Drs Coburn and Norman, particularly as regards the hypercalcemic potential of any analogue of vitamin D, illustrating the great care necessitated in using these compounds. We also concur that the superiority (if any) of one natural or synthetic analogue is yet to be proved, although there are little data in the report from Drs Coburn and Norman's group that 1,25-dihydroxycholecalciferol is effective in reversing the osteomalacic manifestations of uremic bone.1

Drs Coburn and Norman, however, have missed the point of our report, which is to demonstrate the effectiveness of a vitamin D metabolite prior to 1-hydroxylation in the treatment of uremic osteodystrophy. In this regard, we take issue with the contention that interest in the use of vitamin D analogues in uremia center on bypassing "the necessity for 1-hydroxylation in the kidney." Experimental observations of beneficial effect on the uremic skeleton2