S Stancu1,2, C Chiriac1, D T Maria3, E Mota3, G Mircescu1,2, C Capusa1,2. 1. "Carol Davila" University of Medicine and Pharmacy - Nephrology Department, Romania. 2. "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania. 3. Emergency County Hospital - Nephrology Department, Craiova, Romania.
Abstract
CONTEXT: Benefits of vitamin D therapies in chronic kidney disease (CKD) are debated. OBJECTIVE: To compare the effects of medium-term native (VitD) and active (VDRA) vitamin D on parameters of mineral metabolism and arterial function in non-dialysis CKD. DESIGN: Open-label, active comparator, randomized study. SUBJECTS AND METHODS: Forty-eight adult patients, vitamin D naïve, CKD stage 3 to 5 with increased parathyroid hormone (iPTH) were randomized to receive either oral cholecalciferol 1000UI/day (n=24) or paricalcitol 1mcg/day (n=24) for 6 months. Median changes at end of study vs. baseline in serum calcidiol, iPTH, total alkaline phosphatase (ALP), and cardio-ankle vascular index (CAVI) were the efficacy parameters. RESULTS: Higher increase in calcidiol (15.5 [95%CI 13.3; 17.2] vs. 0.4 [95%CI -6.1; 3.7]ng/mL, p<0.001) were found in VitD group. Conversely, the decline of iPTH (-35.2 [95%CI -83; 9] vs. 13.3 [95%CI -8.1; 35]pg/mL, p=0.008) and ALP (-34 [95%CI -58; -11] vs. -10 [95%CI -23; -2]U/L, p=0.02) were greater after paricalcitol. More subjects experienced iPTH decrease in VDRA group (71% vs. 39%, p=0.03). The variation in CAVI and the incidence of hypercalcemia and hyperphosphatemia were similar. CONCLUSIONS: It seems that secondary hyperparathyroidism was more efficiently treated by VDRA, whereas cholecalciferol better corrected the calcidiol deficiency in non-dialysis CKD.
CONTEXT: Benefits of vitamin D therapies in chronic kidney disease (CKD) are debated. OBJECTIVE: To compare the effects of medium-term native (VitD) and active (VDRA) vitamin D on parameters of mineral metabolism and arterial function in non-dialysis CKD. DESIGN: Open-label, active comparator, randomized study. SUBJECTS AND METHODS: Forty-eight adult patients, vitamin D naïve, CKD stage 3 to 5 with increased parathyroid hormone (iPTH) were randomized to receive either oral cholecalciferol 1000UI/day (n=24) or paricalcitol 1mcg/day (n=24) for 6 months. Median changes at end of study vs. baseline in serum calcidiol, iPTH, total alkaline phosphatase (ALP), and cardio-ankle vascular index (CAVI) were the efficacy parameters. RESULTS: Higher increase in calcidiol (15.5 [95%CI 13.3; 17.2] vs. 0.4 [95%CI -6.1; 3.7]ng/mL, p<0.001) were found in VitD group. Conversely, the decline of iPTH (-35.2 [95%CI -83; 9] vs. 13.3 [95%CI -8.1; 35]pg/mL, p=0.008) and ALP (-34 [95%CI -58; -11] vs. -10 [95%CI -23; -2]U/L, p=0.02) were greater after paricalcitol. More subjects experienced iPTH decrease in VDRA group (71% vs. 39%, p=0.03). The variation in CAVI and the incidence of hypercalcemia and hyperphosphatemia were similar. CONCLUSIONS: It seems that secondary hyperparathyroidism was more efficiently treated by VDRA, whereas cholecalciferol better corrected the calcidiol deficiency in non-dialysis CKD.
Authors: Sharon M Moe; Akber Saifullah; Robert E LaClair; Sohail A Usman; Zhangsheng Yu Journal: Clin J Am Soc Nephrol Date: 2010-01-07 Impact factor: 8.237
Authors: Prakash Chandra; José Nilo G Binongo; Thomas R Ziegler; Lynn E Schlanger; Wenli Wang; James T Someren; Vin Tangpricha Journal: Endocr Pract Date: 2008 Jan-Feb Impact factor: 3.443
Authors: Diana Rucker; Marcello Tonelli; Melanie G Coles; Susan Yoo; Kim Young; Alan W McMahon Journal: J Nephrol Date: 2009 Jan-Feb Impact factor: 3.902
Authors: Suetonia C Palmer; David O McGregor; Petra Macaskill; Jonathan C Craig; Grahame J Elder; Giovanni F M Strippoli Journal: Ann Intern Med Date: 2007-12-18 Impact factor: 25.391