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No Positive Cardiac Benefits from Vitamin D for Kidney Disease
By jeremyc | February 15, 2012
A recently concluded multinational clinical trial found that vitamin D therapy did not improve diastolic dysfunction or reduce left ventricular mass in patients suffering from chronic kidney disease.
The left ventricular mass of patients on vitamin D was measured after 48 weeks of treatment, and the change measured was the same as that of patients given a placebo. These results were shared by Dr. Ravi Thadani, MD, who was a researcher in the trial conducted by the Massachusetts General Hospital, Boston.
The report further shows that there was no difference in diastolic lateral mitral annular tissue velocity found between the vitamin D therapy group and placebo therapy group. While the vitamin D treatment showed a peak early velocity of -0.01 cm/s, the placebo treatment showed a velocity of -0.03 cm/s. The complete report of the trial was published in the February 15 edition of the Journal of the American Medical Association.
Chronic kidney disease is often associated with vitamin D deficiency, which is why vitamin D is given to patients diagnosed with the disease. Some observational studies have also suggested a link between chronic kidney disease and heightened cardiovascular risks. The trial aimed at exploring the possibilities of vitamin D treatment in improving cardiac function and structure and countering the cardiovascular risks associated with chronic kidney disease. Dr. Thadani and his colleagues from Massachusetts General Hospital conducted this double-blind clinical trial on 227 randomized patients diagnosed with mild to moderate left ventricular hypertrophy and kidney disease. The patients were prescribed a placebo or paricalcitol.
Most patients in this trial were white men with a mean age of 65 and suffered from hypertension. However, blood pressure levels were well controlled for all hypertensive patients. At the baseline, parathyroid levels were elevated.
At the end of the trial, there were no differences found in the left ventricular volume index and end-systolic volume index on the cardiovascular MRI conducted on patients. Similarly, the aortic wall and plaque volume and left ventricular ejection fraction remained the same for both groups. A trans-thoracic echocardiograph test was also conducted on both groups, and there were no significant differences found in the measurements like the ratio of mitral inflow wave velocity to diastolic mitral annular velocity.
The number of patients hospitalized during the trial was also the same for both groups, but only one out of seven patients hospitalized for cardiovascular problems were on vitamin D therapy. On the other hand, more patients were on active therapy began dialysis than patients on placebo therapy. The mean difference, however, was not very high (P=0.12).
The trial report also states that approximately 80 percent of patients on vitamin D therapy had reported adverse events during their treatment. On the other hand, 78 percent of patients on placebo treatment reported adverse reactions. These average figures are almost the same, but the vitamin D therapy patients suffered from more drug-related problems (21 percent versus 5 percent). The most common drug-related problem reported by this group was hypercalcemia.
The editorial that followed this report called for a bigger study which focused on relevant clinical factors such as hospitalizations for dialysis, cardiac events and death. The limitation of this study was that there was no increase found in left ventricular mass, even though there were declines in glomerular filtration rate. This is in contrast to the results of cross-sectional studies.
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