Effect of alendronate on vascular calcification in CKD stages 3 and 4: a pilot randomized controlled trial.
Abstract | BACKGROUND: STUDY DESIGN: SETTING & PARTICIPANTS: 51 patients with CKD stages 3-4 were recruited from a hospital outpatient setting; 50 were treated with study medication. INTERVENTIONS: Patients were randomly assigned to either alendronate, 70 mg (n = 25), or matching placebo (n = 25), administered weekly. OUTCOMES: MEASUREMENTS: At baseline and 12 and 18 months, computed tomography, pulse wave velocity using SphygmoCor (AtCor Medical, PWV Inc, www.atcormedical.com), and dual-energy x-ray absorptiometry were performed to measure vascular calcification, arterial compliance, and BMD, respectively. Analysis was by intention to treat, with a random-effect linear regression model to assess differences. RESULTS: 46 patients completed the study (24 alendronate, 22 placebo); baseline mean age was 63.1 +/- 1.8 years, estimated glomerular filtration rate was 34.5 +/- 1.4 mL/min/1.73 m(2), 59% had diabetes, and 65% were men. 91% had aortic vascular calcification at the start and 78% showed progression. At 18 months, there was no difference in vascular calcification progression with alendronate compared with placebo (adjusted difference, -24.2 Hounsfield units [95% CI, -77.0 to 28.6]; P = 0.4). There was an increase in lumbar spine BMD (T score difference, +0.3 [95% CI, 0.03-0.6]; P = 0.04) and a trend toward better pulse wave velocity (-1 m/s [95% CI, -2.1 to 0.1]; P = 0.07) with alendronate. Femoral BMD was similar between groups. There was a nonsignificant decrease in kidney function in patients on alendronate therapy compared with placebo (-1.2 mL/min/1.73 m(2) [95% CI, -4.0 to 1.7]). LIMITATIONS: Small sample size and baseline differences, especially with aortic vascular calcification, may have diminished any potential difference between groups. CONCLUSIONS:
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Authors | Nigel D Toussaint, Kenneth K Lau, Boyd J Strauss, Kevan R Polkinghorne, Peter G Kerr |
Journal | American journal of kidney diseases : the official journal of the National Kidney Foundation
(Am J Kidney Dis)
Vol. 56
Issue 1
Pg. 57-68
(Jul 2010)
ISSN: 1523-6838 [Electronic] United States |
PMID | 20347511
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Aged
- Alendronate
(pharmacology, therapeutic use)
- Aorta
(drug effects, pathology)
- Calcinosis
(drug therapy, pathology)
- Female
- Humans
- Kidney
(blood supply, drug effects, pathology)
- Kidney Failure, Chronic
(drug therapy, pathology)
- Male
- Middle Aged
- Pilot Projects
- Vascular Diseases
(drug therapy, pathology)
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