NUTRITIONAL OR ACTIVE VITAMIN D FOR THE CORRECTION OF MINERAL METABOLISM ABNORMALITIES IN NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS?

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.