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(Hypertension. 2008;52:249.)
© 2008 American Heart Association, Inc.

Original Articles

Paricalcitol Reduces Albuminuria and Inflammation in Chronic Kidney Disease

A Randomized Double-Blind Pilot Trial

Pooneh Alborzi; Nina A. Patel; Carla Peterson; Jennifer E. Bills; Dagim M. Bekele; Zerihun Bunaye; Robert P. Light; Rajiv Agarwal

From the Indiana University School of Medicine (P.A., N.A.P., C.P., J.E.B., D.M.B., Z.B., R.P.L., R.A.) and Richard L. Roudebush Veterans’ Administration Medical Center (R.A.), Indianapolis.

Correspondence to Rajiv Agarwal, Indiana University and VAMC, 1481 W 10th St, Indianapolis, IN 46202. E-mail ragarwal{at}iupui.edu

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 µg of paricalcitol, a vitamin D analog, orally for 1 month. Placebo-corrected change in flow mediated dilatation with a 1-µg dose was 0.5% and 0.4% with a 2-µg 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-µg dose, and 0.5 (95% CI: 0.3 to 0.9; P=0. 03) with a 2-µg 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-µg dose, and 0.54 (95% CI: 0.35 to 0.83; P=0. 01) with a 2-µg 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.

Key Words: chronic kidney disease • vitamin D • albuminuria • ambulatory blood pressure • inflammation • endothelial function

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