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.
Highlights
The risk of cardiovascular disease is tremendously high in dialysis patients
In order to explore the influence of vitamin D analogs in hemodialysis patients, we examined the changes in inflammation, cardiac function (Nt-proBNP) and calcification factors during treatment with the vitamin D analogs alfacalcidol and paricalcitol, and the possible differences between the effects of these analogs
We found no differences between alfacalcidol and paricalcitol and their influence on NT-proBNP, OPG or inflammatory markers during 16 weeks of treatment in hemodialysis patients
Summary
The risk of cardiovascular disease is tremendously high in dialysis patients. Vitamin D deficiency is associated with increased risk of cardiovascular disease and mortality in hemodialysis patients [2,3,4,5]. The mechanism of cardiovascular protection by vitamin D analogs has been proposed to be due to antiinflammatory properties [9], modulation of calcification factors and interaction in the bone-vascular crosstalk [10,11], and modulation of cardiac structure and function [12,13,14]. In order to explore the influence of vitamin D analogs in hemodialysis patients, we examined the changes in inflammation (hs-Crp, IL-6 and TNF-α), cardiac function (Nt-proBNP) and calcification factors (fetuin-A and osteoprotegerin) during treatment with the vitamin D analogs alfacalcidol and paricalcitol, and the possible differences between the effects of these analogs
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