Vitamin D seems to protect against
cardiovascular disease, but the reported effects of
vitamin D on patient outcomes in CKD are controversial. We conducted a prospective, double blind, randomized, placebo-controlled trial to determine whether oral activated
vitamin D reduces left ventricular (LV) mass in patients with stages 3-5 CKD with LV
hypertrophy. Subjects with echocardiographic criteria of LV
hypertrophy were randomly assigned to receive either oral
paricalcitol (1 μg) one time daily (
n=30) or matching placebo (
n=30) for 52 weeks. The primary end point was change in LV mass index over 52 weeks, which was measured by cardiac magnetic resonance imaging. Secondary end points included changes in LV volume, echocardiographic measures of systolic and diastolic function, biochemical parameters of
mineral bone disease, and measures of renal function. Change in LV mass index did not differ significantly between groups (median [interquartile range], -2.59 [-6.13 to 0.32] g/m(2) with
paricalcitol versus -4.85 [-9.89 to 1.10] g/m(2) with placebo). Changes in LV volume, ejection fraction, tissue Doppler-derived measures of early diastolic and systolic mitral annular velocities, and ratio of early mitral inflow velocity to early diastolic mitral annular velocity did not differ between the groups. However,
paricalcitol treatment significantly reduced intact
parathyroid hormone (P<0.001) and
alkaline phosphatase (P=0.001) levels as well as the number of cardiovascular-related hospitalizations compared with placebo. In conclusion, 52 weeks of treatment with oral
paricalcitol (1 μg one time daily) significantly improved
secondary hyperparathyroidism but did not alter measures of LV structure and function in patients with severe CKD.