Published Online
on July 7, 2008

A more recent version of this article appeared on August 1, 2008

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Submitted on March 7, 2008
Revised on April 2, 2008

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; and 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.

^* To whom correspondence should be addressed. E-mail: ragarwal{at}iupui.edu.

Abstract—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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