Cholecalciferol, Calcitriol, and Vascular Function in CKD: A Randomized, Double-Blind Trial

Clinical journal of the American Society of Nephrology: CJASN

Jessica Kendrick¹ 

[1] Divisions of *Renal Diseases and Hypertension and..Divisions of *Renal Diseases and Hypertension and..Divisions of *Renal Diseases and Hypertension and..‡Geriatrics, University of Colorado School of Medicine, Aurora, Colorado;Divisions of *Renal Diseases and Hypertension and..Divisions of *Renal Diseases and Hypertension and..§Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado..Divisions of *Renal Diseases and Hypertension and..

关键词: chronic kidney disease;    Vitamin D;    vascular disease;    clinical trial;    Adult;    Brachial Artery;    Calcifediol;    Calcitriol;    Cholecalciferol;    Dilatation;    Double-Blind Method;    glomerular filtration rate;    Humans;    Inflammation;    Minerals;    parathyroid hormone;    Prospective Studies;    Renal Insufficiency, Chronic;    Vitamins;    25-hydroxyvitamin D;   

DOI  :  10.2215/CJN.01870217

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives High circulating vitamin D levels are associated with lower cardiovascular mortality in CKD, possibly by modifying endothelial function. We examined the effect of calcitriol versus cholecalciferol supplementation on vascular endothelial function in patients with CKD.Design, setting, participants, & measurements We performed a prospective, double-blind, randomized trial of 128 adult patients with eGFR=15–44 ml/min per 1.73 m2and serum 25-hydroxyvitamin D level <30 ng/ml at the University of Colorado. Participants were randomly assigned to oral cholecalciferol (2000 IU daily) or calcitriol (0.5 μg) daily for 6 months. The primary end point was change in brachial artery flow-mediated dilation. Secondary end points included changes in circulating markers of mineral metabolism and circulating and cellular markers of inflammation.Results One hundred and fifteen patients completed the study. The mean (SD) age and eGFR of participants were 58±12 years old and 33.0±10.2 ml/min per 1.73 m2, respectively. There were no significant differences between groups at baseline. After 6 months, neither calcitriol nor cholecalciferol treatment resulted in a significant improvement in flow-mediated dilation (mean±SD percentage flow-mediated dilation; calcitriol: baseline 4.8±3.1%, end of study 5.1±3.6%; cholecalciferol: baseline 5.2±5.2%, end of study 4.7±3.6%); 25-hydroxyvitamin D levels increased significantly in the cholecalciferol group compared with the calcitriol group (cholecalciferol: 11.0±9.5 ng/ml; calcitriol: −0.8±4.8 ng/ml; P<0.001). Parathyroid hormone levels decreased significantly in the calcitriol group compared with the cholecalciferol group (median [interquartile range]; calcitriol: −22.1 [−48.7–3.5] pg/ml; cholecalciferol: −0.3 [−22.6–16.9] pg/ml; P=0.004).Conclusions Six months of therapy with calcitriol or cholecalciferol did not improve vascular endothelial function or improve inflammation in patients with CKD.

【 授权许可】

CC BY