Efficiency of delivery observed treatment in hemodialysis patients: the example of the native vitamin D therapy

Introduction Adherence to therapy is a relevant challenge
in chronic hemodialysis patients. The directly observed
therapy (DOT) could be an effective method to increase
adherence for specific therapies. We aimed to study the
performance of DOT versus home medication. We follow
the impact of providing native vitamin D directly by the
nurse after a dialysis session on the 25-hydroxyvitamin
[25(OH)D] concentrations.
Methods In this observational study, we included 38
dialysis patients treated by stable dosage of cholecalciferol.
DOT was implemented in December 2010. We considered
the concentrations of 25-OH vitamin D three times before
(T1 = June 2010, T2 = July 2010 and T3 = September
2010) and three times after the modification of prescription
(T4 = February 2011, T5 = March 2011 and T6 = April
2011).
Results Median age was 72 [62; 79] years and 48 % were
diabetics. Mean body mass index was 26 ± 5 kg/m2 and
median dialysis vintage was 20 [8; 46] months. The patients
were compared to themselves. Before DOT, median
concentrations of 25(OH)D were 27 (14–36), 23 (17–31),
31 (22–38) ng/mL at T1, T2 and T3, respectively. When
DOT was effective, the concentrations significantly increased
to 34 (28–44), 35 (29–41), 39 (32–47) ng/mL at
T4, T5 and T6, respectively. Before DOT, 19 patients
(50 %) reached the target of 30 ng/mL. After DOT, 29
patients (76 %) reached the target concentration of 30 ng/
mL.
Conclusions In hemodialysis patients, DOT is both simple
and effective to increase the therapeutic impact to native
vitamin D.