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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Vitamin D supplementation for the improvement of vascular function in patients with chronic kidney disease: a
Ding Dou1,2, Bing Yang3, Hongqiao Gan3
1Basic Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China.
Insights
Vitamin D may improve vascular function in chronic kidney disease (CKD) patients, particularly certain forms like cholecalciferol and paricalcitol. Further research is needed to confirm these findings in larger, longer trials.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Endocrinology
Background:
- Vascular dysfunction is a significant concern in chronic kidney disease (CKD).
- The role of vitamin D supplementation in improving vascular health in CKD patients remains unclear.
- This meta-analysis investigates the efficacy of vitamin D on vascular function in CKD.
Purpose of the Study:
- To evaluate the impact of vitamin D on vascular function in patients with chronic kidney disease.
- To synthesize findings from randomized controlled trials (RCTs) on vitamin D and vascular parameters in CKD.
Main Methods:
- A systematic search of major databases (Medline, Embase, Cochrane) and clinical trial registries was conducted.
- Included RCTs compared vitamin D supplementation against a placebo in CKD patients.
- Meta-analysis and subgroup analyses were performed to assess outcomes like flow-mediated dilation (FMD) and pulse wave velocity (PWV).
Main Results:
- Overall, vitamin D showed no significant effect on FMD, but subgroup analysis revealed significant improvements with cholecalciferol and 2 mcg of paricalcitol.
- Vitamin D significantly reduced pulse wave velocity (PWV) in CKD patients.
- Significant differences were observed in calcium, parathyroid hormone, and 25-hydroxyvitamin D levels between vitamin D and placebo groups.
Conclusions:
- Vitamin D supplementation may offer benefits for vascular function in CKD patients.
- The efficacy of vitamin D appears dependent on the specific form and dosage used.
- Earlier stages of CKD may show a better response to vitamin D; larger, longer trials are recommended for definitive evidence.
Background:
The efficacy of vitamin D on vascular function remains controversial in chronic kidney disease (CKD) patients. The aim of the present work was to perform a meta-analysis of randomized controlled trials to evaluate the efficacy of vitamin D on vascular function in CKD patients.
Methods:
We searched Medline, the Cochrane Central Register of Controlled Trials, Embase, the Science Citation Index, and clinical trial registries for randomized controlled trials comparing vitamin D with a placebo in CKD patients.
Results:
We included seven trials. For flow-mediated dilation (FMD), there was no significant difference between the two groups (WMD 1.66%; 95% CI - 0.2 to 3.51, p = 0.08; with significant heterogeneity, p < 0.0001, I2 = 89%). We conducted a subgroup analysis. In the cholecalciferol group, compared with the placebo group, cholecalciferol significantly increased FMD (WMD 5.49%; 95% CI 4.36-6.62, p < 0.0001). In the 2 ug paricalcitol group, compared with the placebo group, paricalcitol significantly increased FMD (WMD 2.09%; 95% CI 1.28-2.9, p < 0.0001; without significant heterogeneity, p = 0.47, I2 = 0%). In the 1 ug paricalcitol group, there was no significant difference between the two groups. For pulse wave velocity (PWV), vitamin D significantly decreased PWV compared with the placebo (WMD - 0.93 m/s; 95% CI - 1.71 to - 0.15, p = 0.02; without significant heterogeneity, p = 0.14, I2 = 45%). For calcium (Ca) and parathyroid hormone (PTH), there was a significant difference between the vitamin D group and the placebo group. For 25-hydroxyvitamin D [25(OH)D], there was a significant difference between the inactive vitamin D group and the placebo group. For phosphorus (P), systolic blood pressure (SBP), and diastolic blood pressure (DBP), there were no significant differences between the two groups.
Conclusions:
We speculate that vitamin D might be able to improve vascular function in CKD patients. The effect of vitamin D might be associated with its doses and earlier stages of the disease might respond better to vitamin D. Furthermore, trials with larger populations and longer durations are needed in order to provide more reliable evidence.
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