Paricalcitol reduces albuminuria and inflammation in chronic kidney disease: a randomized double-blind pilot trial.

Abstract

Vitamin D receptor activation is associated with improved survival in patients with chronic kidney disease, but the mechanism of this benefit is unclear. To better understand the effects of vitamin D on endothelial function, blood pressure, albuminuria, and inflammation in patients with chronic kidney disease (2 patients stage 2, remaining stage 3), we conducted a pilot trial in 24 patients who were randomly allocated equally to 3 groups to receive 0, 1, or 2 microg of paricalcitol, a vitamin D analog, orally for 1 month. Placebo-corrected change in flow mediated dilatation with a 1-microg dose was 0.5% and 0.4% with a 2-microg dose (P>0.2). At 1 month, the treatment:baseline ratio of high sensitivity C-reactive protein was 1.5 (95% CI: 1.1 to 2.1; P=0.02) with placebo, 0.8 (95% CI: 0.3 to 1.9; P=0.62) with a 1-microg dose, and 0.5 (95% CI: 0.3 to 0.9; P=0. 03) with a 2-microg dose of paricalcitol. At 1 month, the treatment:baseline ratio of 24-hour albumin excretion rate was 1.35 (95% CI: 1.08 to 1.69; P=0.01) with placebo, 0.52 (95% CI: 0.40 to 0.69; P<0.001) with a 1-microg dose, and 0.54 (95% CI: 0.35 to 0.83; P=0. 01) with a 2-microg dose (P<0.001 for between group changes). No differences were observed in iothalamate clearance, 24-hour ambulatory blood pressure, or parathyroid hormone with treatment or on washout. Thus, paricalcitol-induced reduction in albuminuria and inflammation may be mediated independent of its effects on hemodynamics or parathyroid hormone suppression. Long-term randomized, controlled trials are required to confirm these benefits of vitamin D analogs.

• Authors: Pooneh Alborzi, Nina A Patel, Carla Peterson, Jennifer E Bills, Dagim M Bekele, Zerihun Bunaye, Robert P Light, Rajiv Agarwal
• Journal: Hypertension (Dallas, Tex. : 1979) (Hypertension) Vol. 52 Issue 2 Pg. 249-55 (Aug 2008) ISSN: 1524-4563 [Electronic] United States
• PMID: 18606901 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Ergocalciferols
• Inflammation Mediators
• paricalcitol

Topics

• Aged
• Aged, 80 and over
• Albuminuria (diagnosis, epidemiology, prevention & control)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Ergocalciferols (administration & dosage)
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• Humans
• Inflammation Mediators (metabolism)
• Kidney Failure, Chronic (diagnosis, drug therapy, mortality)
• Kidney Function Tests
• Male
• Middle Aged
• Probability
• Reference Values
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome