The influence of vitamin D analogs on calcification modulators, N-terminal pro-B-type natriuretic peptide and inflammatory markers in hemodialysis patients: a randomized crossover study

Abstract

BackgroundThe risk of cardiovascular disease is tremendously high in dialysis patients. Dialysis patients treated with vitamin D analogs show decreased cardiovascular morbidity and mortality compared with untreated patients. We examined the influence of two common vitamin D analogs, alfacalcidol and paricalcitol, on important cardiovascular biomarkers in hemodialysis patients. Anti-inflammatory effects and the influence on regulators of vascular calcification as well as markers of heart failure were examined.MethodsIn 57 chronic hemodialysis patients enrolled in a randomized crossover trial comparing paricalcitol and alfacalcidol, we examined the changes in osteoprotegerin, fetuin-A, NT-proBNP, hs-Crp, IL-6 and TNF-α, during 16 weeks of treatment.ResultsNT-proBNP and osteoprotegerin increased comparably in the paricalcitol and alfacalcidol-treated groups. Fetuin-A increased significantly in the alfacalcidol-treated group compared with the paricalcitol-treated group (difference 32.84 μmol/l (95% C.I.; range 0.21–67.47)) during the first treatment period. No difference was found between the groups during the second treatment period, and IL-6, TNF-α and hs-Crp were unchanged in both treatment groups.ConclusionsParicalcitol and alfacalcidol modulate regulators of vascular calcification. Alfacalcidol may increase the level of the calcification inhibitor fetuin-A. We did not find any anti-inflammatory effect or difference in changes of NT-proBNP.Trial registryClinicalTrials.gov NCT00469599 May 3 2007.

Which Biomarker is the Best for Predicting Mortality in Incident Peritoneal Dialysis Patients

“…In the present study, additional analysis revealed that there were no significant differences in NT-proBNP, CRP levels, and PTH levels between patients with and without vitamin D supplements or analogues treatment. Even though several previous studies showed that stimulation of vitamin D receptors reduced BNP levels, 46 – 51 some recent published data demonstrated that there was no significant association between vitamin D supplements and NT-proBNP concentrations in dialysis patients, 52 – 54 supporting the results of the present study.…”

The interaction effects of aerobic exercise training and vitamin D supplementation on plasma lipid profiles and insulin resistance in ovariectomized rats

“…There are positive correlations between low 25-hydroxyvitamin D [25(OH)D; < 43 nmol/L] and obesity [ 10 ] as well as between 25(OH)D < 33–37.5 nmol/L and cardiovascular mortality [ 11 ]. Vitamin D has a protective effect on bones [ 12 ], anticancer [ 13 ] and anti inflammatory [ 14 ] effects and its receptors are present in pancreatic b cells and insulin sensitive tissues including skeletal muscle tissues [ 15 ]. Vitamin D repletion improves insulin and glucose homeostasis in animal models of vitamin D deficiency [ 16 , 17 ].…”

Update on Inflammation in Chronic Kidney Disease

“…Stubbs et al reported that cholecalciferol supplementation altered calcitriol-responsive monocyte proteins and decreased inflammatory cytokines in 7 HD patients [79]. Conversely, recent randomized crossover trial did not find differences in IL-6, TNF-α and CRP following vitamin D analogs supplementation in chronic HD patients [80]. …”