Vitamin D Supplementation Is Associated With Stabilization of Cardiac Autonomic Tone in IgA Nephropathy

Mann, Michelle; Hemmelgarn, Brenda R.; Exner, Derek V.; Hanley, David A.; Turin, Tanvir Chowdhury; Wheeler, David C.; Sola, Darlene Y.; Ellis, Linda; Ahmed, Sofia B.

doi:10.1161/hypertensionaha.115.05688

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…No participants were vitamin D sufficient at baseline, with approximately half of the participants vitamin D insufficient ( n = 31) and half vitamin D deficient ( n = 25). All participants demonstrated low levels of serum 1,25-dihydroxy vitamin D [18,19]. Measures of circulating components of the RAS were markedly elevated [18] but similar between groups.…”

Section: Resultsmentioning

confidence: 99%

“…Vitamin D deficiency is associated with cardiovascular risk in ESKD [6,7,13,14], and limited data suggests that supplementation may mitigate risk in this population [16,17] via favourable alterations in HRV [18,19]. In this blinded, randomized controlled trial, administration of both nutritional and activated (intensive) vitamin D supplementation compared with activated vitamin D alone (conventional) did not alter HRV among patients with ESKD on thrice weekly hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously shown that in both healthy volunteers and subjects with IgA nephropathy, oral vitamin D3 supplementation was associated with normalization of autonomic tone due to significantly increased vagal (HF) activity in response to angiotensin II [18,19], a chronically upregulated hormone in the ESKD population. As a result of this increase in vagal tone, there was an overall decrease in the LF:HF ratio.…”

Section: Discussionmentioning

confidence: 99%

“…Though an increase in LF:HF ratio is associated with improved cardiac outcomes in non-ESKD populations [24], we hypothesized, based on our previous studies [18,19], that vitamin D supplementation would result in an overall decrease in LF:HF due a significant increase in HF. Furthermore, we also hypothesized that intensive vitamin D therapy would have a greater effect on LF:HF compared to conventional vitamin D alone.…”

Section: Methodsmentioning

confidence: 99%

“…While, to date, no randomized trials have shown increased survival with vitamin D supplementation [15,16,17] in ESKD, treatment with the activated vitamin D analogue paricalcitol decreased cardiovascular-related hospitalizations compared to those treated with placebo [16,17]. We have previously shown that vitamin D3 supplementation is associated with normalization of HRV in healthy humans [18] and increased cardioprotective vagal activity in patients with Immunoglobluin A (IgA) nephropathy [19], suggesting that low vitamin D levels may mediate increased risk via the cardiac autonomic nervous system, though this has not been examined in a randomized-controlled trial.…”

Section: Introductionmentioning

confidence: 99%

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The VITAH Trial—Vitamin D Supplementation and Cardiac Autonomic Tone in Patients with End-Stage Kidney Disease on Hemodialysis: A Blinded, Randomized Controlled Trial

et al. 2016

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End-stage kidney disease (ESKD) patients are at increased cardiovascular risk. Vitamin D deficiency is associated with depressed heart rate variability (HRV), a risk factor depicting poor cardiac autonomic tone and risk of cardiovascular death. Vitamin D deficiency and depressed HRV are highly prevalent in the ESKD population. We aimed to determine the effects of oral vitamin D supplementation on HRV ((low frequency (LF) to high frequency (HF) spectral ratio (LF:HF)) in ESKD patients on hemodialysis. Fifty-six subjects with ESKD requiring hemodialysis were recruited from January 2013–March 2015 and randomized 1:1 to either conventional (0.25 mcg alfacalcidol plus placebo 3×/week) or intensive (0.25 mcg alfacalcidol 3×/week plus 50,000 international units (IU) ergocalciferol 1×/week) vitamin D for six weeks. The primary outcome was the change in LF:HF. There was no difference in LF:HF from baseline to six weeks for either vitamin D treatment (conventional: p = 0.9 vs. baseline; intensive: p = 0.07 vs. baseline). However, participants who remained vitamin D-deficient (25-hydroxyvitamin D < 20 ng/mL) after treatment demonstrated an increase in LF:HF (conventional: n = 13, ∆LF:HF: 0.20 ± 0.06, p < 0.001 vs. insufficient and sufficient vitamin D groups; intensive: n = 8: ∆LF:HF: 0.15 ± 0.06, p < 0.001 vs. sufficient vitamin D group). Overall, six weeks of conventional or intensive vitamin D only augmented LF:HF in ESKD subjects who remained vitamin D-deficient after treatment. Our findings potentially suggest that while activated vitamin D, with or without additional nutritional vitamin D, does not appear to improve cardiac autonomic tone in hemodialysis patients with insufficient or sufficient baseline vitamin D levels, supplementation in patients with severe vitamin D deficiency may improve cardiac autonomic tone in this higher risk sub-population of ESKD. Trial Registration: ClinicalTrials.gov, NCT01774812.

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Section: Resultsmentioning

confidence: 99%