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Updated: Mar 31, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Paricalcitol, Microvascular and Endothelial Function in Non-Diabetic Chronic Kidney Disease: A Randomized Trial
Kristina Lundwall1, Gun Jörneskog, Stefan H Jacobson
1Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
Insights
Vitamin D receptor activator (VDRA) treatment with paricalcitol may improve endothelial function in patients with moderate chronic kidney disease (CKD). This 3-month study found that higher VDRA doses potentially attenuated declines in vascular function.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Endocrinology
Background:
- Cardiovascular disease risk is elevated in chronic kidney disease (CKD) patients due to vitamin D deficiency, sympathetic activation, and endothelial dysfunction.
- The role of vitamin D and vitamin D receptor activator (VDRA) treatment in moderate CKD remains unclear.
- This study investigated VDRA's impact on sympathetic activity and vascular dysfunction in non-diabetic CKD patients.
Purpose of the Study:
- To assess if VDRA treatment can improve sympathetic activation and macro- and microvascular dysfunction in moderate CKD.
- To evaluate the efficacy of different paricalcitol doses on endothelial function.
- To determine the effect of VDRA on muscle sympathetic nerve activity (MSNA), pulse wave velocity (PWV), and microcirculation.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 36 non-diabetic patients with moderate CKD (eGFR 40 ml/min/1.73 m²).
- Participants received placebo, 1 μg, or 2 μg of paricalcitol (a VDRA) for 3 months.
- Vascular function was assessed using microneurography (MSNA), tonometry (PWV), brachial ultrasound (flow-mediated dilation, FMD), iontophoresis, and videophotometric capillaroscopy (capillary blood velocity, CBV).
Main Results:
- Endothelial function significantly declined over 3 months, except in the 2 μg paricalcitol group.
- The higher VDRA dose (2 μg) showed a trend towards attenuating the decline in microvascular endothelial function and FMD.
- A borderline significant improvement in CBV was observed in treated groups; no significant changes in MSNA, PWV, or albuminuria were noted.
Conclusions:
- Endothelial function deteriorates in moderate CKD over 3 months.
- VDRA treatment, particularly at a higher dose, may ameliorate this decline in endothelial function.
- Further research is warranted to confirm the benefits of VDRA in managing cardiovascular risk in CKD.
Background:
Vitamin D deficiency, sympathetic activation and endothelial dysfunction are associated with increased cardiovascular risk in patients with chronic kidney disease (CKD). Studies have so far failed to establish the role of vitamin D and vitamin D receptor activator (VDRA) treatment in moderate CKD. This trial was designed to assess whether VDRA treatment can ameliorate sympathetic activation and macro- and microvascular dysfunction in non-diabetic patients with moderate CKD.
Methods:
We conducted a randomized controlled double-blind trial using placebo, 1 or 2 μg of paricalcitol, a VDRA, for 3 months. We assessed muscle sympathetic nerve activity (MSNA) by microneurography, pulse wave velocity (PWV) by tonometry, flow mediated vasodilatation (FMD) by brachial ultrasound, skin microcirculation assessed by iontophoresis and capillary blood velocity (CBV) by videophotometric capillaroscopy.
Results:
Thirty-six patients with a mean age of 65 years and mean estimated glomerular filtration rate of 40 ml/min/1.73 m2 were included. We found a significant decline in endothelial function after 3 months, except in the group receiving 2 μg of paricalcitol. The higher dose (2 μg) seemed to attenuate the decline in microvascular endothelial function, assessed by iontophoresis of acetylcholine (p=0.06 for all groups, p=0.65 for the 2 μg group) and for FMD (p=0.006 for all groups, p=0.54 for the 2 μg group). We found a borderline significance (p=0.05) for improved CBV in the treated groups. We found no significant changes between treatments in MSNA, PWV or albuminuria.
Conclusions:
Endothelial function declined significantly over 3 months in patients with moderate CKD, and this decline could be ameliorated by VDRA treatment (NCT01204528).
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