VDRA therapy is associated with improved survival in dialysis patients with serum intact PTH &lt;=150 pg/mL: results of the Italian FARO Survey

Cozzolino, Mario; Brancaccio, Diego; Cannella, Giuseppe; Gesualdo, Loreto; Marangella, Martino; Lodeserto, C; Pozzato, Marco; Rombolà, Giuseppe; Costanzo, Anna Maria; Paparatti, Umberto di Luzio; Mazzaferro, Sandro

doi:10.1093/ndt/gfs108

Cited by 54 publications

(43 citation statements)

References 38 publications

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“…15,26,27 Some retrospective and observational analyses as well as shortterm uncontrolled data suggested potential survival or cardiovascular benefit of 1,25(OH) 2 D 3 treatment in patients with CKD. [17][18][19]28,29 However, controlled data remain scarce. Thus, this background provides important rationale for our study to examine whether paricalcitol, an activated form of vitamin D, may be a useful therapeutic strategy in retarding LV , and E/E9 ratio) over a 52-week period.…”

Section: Discussionmentioning

confidence: 99%

Effect of Paricalcitol on Left Ventricular Mass and Function in CKD—The OPERA Trial

Wang

Fang

Chan

et al. 2014

Journal of the American Society of Nephrology

218

180

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Vitamin D seems to protect against cardiovascular disease, but the reported effects of vitamin D on patient outcomes in CKD are controversial. We conducted a prospective, double blind, randomized, placebocontrolled trial to determine whether oral activated vitamin D reduces left ventricular (LV) mass in patients with stages 3-5 CKD with LV hypertrophy. Subjects with echocardiographic criteria of LV hypertrophy were randomly assigned to receive either oral paricalcitol (1 mg) one time daily (n=30) or matching placebo (n=30) for 52 weeks. The primary end point was change in LV mass index over 52 weeks, which was measured by cardiac magnetic resonance imaging. early diastolic and systolic mitral annular velocities, and ratio of early mitral inflow velocity to early diastolic mitral annular velocity did not differ between the groups. However, paricalcitol treatment significantly reduced intact parathyroid hormone (P,0.001) and alkaline phosphatase (P=0.001) levels as well as the number of cardiovascular-related hospitalizations compared with placebo. In conclusion, 52 weeks of treatment with oral paricalcitol (1 mg one time daily) significantly improved secondary hyperparathyroidism but did not alter measures of LV structure and function in patients with severe CKD.

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Section: Discussionmentioning

confidence: 99%

Effect of Paricalcitol on Left Ventricular Mass and Function in CKD—The OPERA Trial

Wang

Fang

Chan

et al. 2014

Journal of the American Society of Nephrology

218

180

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show abstract

“…By the way, the proportion of those under vitamin D treatment at baseline (17.6%) is lower than that of previous study (30-50%). 11,29 Vitamin D has been known to be associated with improved survival in dialysis patients. Hypocalcemia is associated with mortality in baseline model.…”

Section: Discussionmentioning

confidence: 99%

Associations among time-average mineral values, mortality and cardiovascular events in hemodialysis patients

Lee

Wang

2015

Renal Failure

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Mineral and bone disease (CKD-MBD), disorders of mineral metabolism, is associated with mortality and cardiovascular disease in dialysis patients. However, the associations among time average mineral values (P, Ca and PTH) and clinical outcomes are not well investigated. Objectives: This study examines the associations among mineral values and clinical outcomes from a single medical center. Methods: Adult patients who initiate hemodialysis in Taoyuan General Hospital from 2008 to 2013 were enrolled. We examined these associations using baseline and time-average model. The clinical outcomes included mortality, major adverse cardiovascular events (MACE) and cardiovascular events. We also examined the association between achieve K/DOQI guidelines' targets and clinical outcomes. Results: From a total of 284 hemodialysis patients, none of the baseline mineral values is associated with mortality and cardiovascular event, except hyperphosphatemia. Compared to patients achieved K/DOQI guidelines' targets, time average hyperphosphatemia is associated with MACE and first cardiovascular event [the adjusted hazard ratios (AHRs) are 6.343 and 3.278); whereas time average hypercalcemia is associated with MACE marginally (the AHR is 5.964). None of above clinical outcomes is related to hyperparathyroidism. The AHRs for mortality in those who only met PTH targets and none of the mineral value targets are 1.73 and 1.74, whereas the AHRs for cardiovascular events in those who met only Ca, only PTH, and none of the targets are 1.73, 1.81 and 2.54 (all ps50.05). Conclusion: Time-average phosphate is associated with cardiovascular events after initiation of dialysis. Among mineral values, serum phosphate is still the strongest predictor for mortality and cardiovascular events. KeywordsCardiovascular events, CKD-MBD, major adverse cardiovascular event, mineral and bone disorder, mortality History

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“…The KDIGO CKD-MBD guideline suggests that the level is measured in CKD stages 3-5 and dialysis; and replaced if deficiency or insufficiency is detected (37). It is a weak recommendation given the lack of conclusive evidence on patient level outcome from randomised controlled trials (RCTs) although a number of large observational studies showed a survival benefit associated with vitamin D treatment in CKD and dialysis patients (46,(77)(78)(79)(80)(81)(82). The dose of vitamin D that should be used is also unclear in the guideline, so the dose in our treatment algorithm (Figure 2) is based on our local guideline.…”

Section: Vitamin Dmentioning

confidence: 99%

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

Salam

Khwaja

Wilkie

2016

Drugs

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or Article Brief (if supplied by editors): As a 'Therapy in Practice' article, we would like this to provide a succinct, up-to-date clinically orientated guide to the optimum management of secondary hyperparathyroidism in patients with chronic kidney disease. The review should include an appropriate background to the development of SHPT. It should focus primarily on pharmacological treatments but as appropriate, non-pharmacological approaches (dietary, surgical) may be discussed to fully place pharmacological therapy in context. Submission date: 31 st March 2016Word count: 4156 Compliance with Ethical StandardsFunding and conflict of interest statement from each author: Takeaway messages from the article SHPT is associated with adverse outcomes in CKD and dialysis patients  Optimum PTH level is unclear in pre-dialysis CKD and the recommended range is wide for dialysis patients.  Management of SHPT is largely pharmacological focussing on lowering PTH  PTH lowering treatment has not shown improved cardiovascular risk, fractures and mortality. AbstractSecondary hyperparathyroidism (SHPT) is a common complication of CKD and is part of the chronic kidney disease-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of fracture and mortality, thus SHPT control is recommended as kidney function declines. Effective SHPT management becomes more difficult once skeletal and cardiovascular adverse effects associated with severe SHPT have become established. However, interventional studies to lower parathyroid hormone (PTH) have so far shown inconsistent results in improving patient-centred outcomes such as mortality, cardiovascular events and fracture. Pharmacological treatment effect on PTH level is also inconsistent between predialysis CKD and dialysis patients which adds to the complexity of SHPT management. This review aims to give an overview on the pathophysiology, pharmacological and non-pharmacological treatment for SHPT in CKD including some of the limitations of current therapeutic options.

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VDRA therapy is associated with improved survival in dialysis patients with serum intact PTH <=150 pg/mL: results of the Italian FARO Survey

Abstract: Results from this observational study suggest that VDRA therapy was associated with improved survival in dialysis patients, even with low serum iPTH levels.

Cited by 54 publications

References 38 publications

Effect of Paricalcitol on Left Ventricular Mass and Function in CKD—The OPERA Trial

Effect of Paricalcitol on Left Ventricular Mass and Function in CKD—The OPERA Trial

Associations among time-average mineral values, mortality and cardiovascular events in hemodialysis patients

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

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