Oral paricalcitol as antiproteinuric agent in chronic kidney disease.

Abstract

BACKGROUND:

Vitamin D has an important regulatory effect on the renin-angiotensin-aldosterone system, playing a central role in the regulation of proteinuria. We therefore studied the antiproteinuric effect of paricalcitol.

METHODS:

36 patients with an estimated GFR of 30-90 mL/min/1.73 m² and proteinuria >400 mg/d with a stable dose of ACE inhibitor or ARB for at least 3 months were recruited. Patients received oral paricalcitol 1 µg/day for 12 months. Primary endpoint was decrease in proteinuria from baseline. Secondary endpoints were changes in creatinine, eGFR, serum levels of calcium, phosphorus, iPTH, 25(OH)vitD, C-Reactive Protein and blood presure.

RESULTS:

Mean proteinuria was 2806 mg/d and fell to 2199 mg/d at month 6 (p<.0001) and 1931.5 mg/d at month 12 (P<.0001). Patients with >3000 mg/d baseline proteinuria (n=12) saw smaller relative reductions in proteinuria (5956.9±2492.6 mg/d to 4220.4±2613 mg/d at 12 months) than patients with <3000 mg/d baseline proteinuria (1371±627.5 mg/d to 821.3±491.5mg/d at 12 months). There were no changes in BP, eGFR and CRP. We observed significant changes in serum levels of calcium, phosphorus, iPTH, 25(OH) vitamin D.

CONCLUSION:

Our study shows an important reduction in proteinuria with a low dose of oral paricalcitol in CKD, that is particularly robust with baseline proteinuria between 1-3 g/d.

• Authors: Alberto de Lorenzo, Laura Salanova, Andrew S Bomback, María Moya, Francisco Coronel, Carmen Bernis, José A Sánchez-Tomero, Vicente Álvarez
• Journal: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia (Nefrologia) Vol. 33 Issue 5 Pg. 709-15 ( 2013) ISSN: 1989-2284 [Electronic] Spain
• PMID: 24089163 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Ergocalciferols
• Parathyroid Hormone
• Vitamin D
• Phosphorus
• paricalcitol
• C-Reactive Protein
• 25-hydroxyvitamin D
• Creatinine
• Calcium

Topics

• Aged
• Aged, 80 and over
• Angiotensin II Type 1 Receptor Blockers (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Blood Pressure (drug effects)
• C-Reactive Protein (analysis)
• Calcium (blood)
• Chronic Disease
• Creatinine (blood)
• Ergocalciferols (administration & dosage, therapeutic use)
• Female
• Follow-Up Studies
• Glomerular Filtration Rate (drug effects)
• Humans
• Kidney Diseases (blood, complications, drug therapy, urine)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Phosphorus (blood)
• Proteinuria (etiology, prevention & control)
• Treatment Outcome
• Vitamin D (analogs & derivatives, blood)