The Effect of Long-Term Cholecalciferol Supplementation on Vascular Calcification in Chronic Kidney Disease Patients With Hypovitaminosis D

Samaan, Farid; Carvalho, Aluízio Barbosa de; Pillar, Roberta; Rocha, Lillian Andrade da; Cassiolato, José Luiz; Cuppari, Lílian; Canziani, María Eugênia Fernandes

doi:10.1053/j.jrn.2018.12.002

Cited by 8 publications

(7 citation statements)

References 27 publications

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“…Six trials involved vitamin D therapy with 289 participants (median participants 44, range 36–76; median duration 15 months, range 6–60 months) (Table 4). 57 – 62 Half of these studies involved nutritional vitamin D (cholecalciferol) and half evaluated effects on VC of active vitamin D analogs (calcitriol and paricalcitol). All studies showed no difference in VC between groups, regardless of whether the vitamin D intervention was compared with placebo, standard of care, or another vitamin D comparator.…”

Section: Resultsmentioning

confidence: 99%

“…Studies examining the effect of various forms of vitamin D treatment on VC, across the stages of CKD, do not indicate benefit for reducing progression of VC. Interestingly, even trials involving CKD participants with documented vitamin D deficiency did not demonstrate any beneficial effect of vitamin D supplementation on VC 59 – 61 . Studies have demonstrated that calcitriol and other vitamin D receptor activators in nondialysis CKD participants may increase the risk of hypercalcemia, without cardiovascular benefit 102 , 103 .…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, even trials involving CKD participants with documented vitamin D deficiency did not demonstrate any beneficial effect of vitamin D supplementation on VC. [59][60][61] Studies have demonstrated that calcitriol and other vitamin D receptor activators in nondialysis CKD participants may increase the risk of hypercalcemia, without cardiovascular benefit. 102,103 The updated KDIGO CKD-MBD guidelines have consequently recommended reserving the use of calcitriol and other vitamin D receptor analogs for people with CKD who have severe and progressive SHPT.…”

Section: Discussionmentioning

confidence: 99%

“…The largest study, conducted by Raggi et al (n5360), reported a nonsignificant reduction in progression of CAC determined by the Agatston score with cinacalcet plus low-dose vitamin D analogs compared with vitamin D analogs alone, 52 but reported a significant attenuation when CAC was measured 4). [57][58][59][60][61][62] Half of these studies involved nutritional vitamin D (cholecalciferol) and half evaluated effects on VC of active vitamin D analogs (calcitriol and paricalcitol). All studies showed no difference in VC between groups, regardless of whether the vitamin D intervention was compared with placebo, standard of care, or another vitamin D comparator.…”

Section: Calcimimeticsmentioning

confidence: 99%

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Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials

Smith

Tiong

et al. 2022

JASN

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Background Vascular calcification is associated with cardiovascular morbidity and mortality in people with chronic kidney disease (CKD). Evidence-based interventions that may attenuate its progression in CKD remain uncertain. Methods We conducted a systematic review of prospective clinical trials of interventions to attenuate vascular calcification in people with CKD, compare with placebo, another comparator, or standard of care. We included prospective clinical trials (randomized and nonrandomized) involving participants with stage 3-5D CKD or kidney transplant recipients; the outcome was vascular calcification measured using radiological methods. Quality of evidence was determined by the Cochrane risk of bias assessment tool and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method. Results There were 77 trials (63 randomized) involving 6898 participants eligible for inclusion (median sample size, 50; median duration, 12 months); 58 involved participants on dialysis, 15 involved individuals with nondialysis CKD, and 4 involved kidney transplant recipients. Risk of bias was moderate over all. Trials involving magnesium and sodium thiosulfate consistently showed attenuation of vascular calcification. Trials involving intestinal phosphate binders, alterations in dialysate calcium concentration, vitamin K therapy, calcimimetics, and antiresorptive agents had conflicting or inconclusive outcomes. Trials involving vitamin D therapy and HMG-CoA reductase inhibitors did not demonstrate attenuation of vascular calcification. Mixed results were reported for single studies of exercise, vitamin E-coated or high-flux hemodialysis membranes, interdialytic sodium bicarbonate, SNF472, spironolactone, sotatercept, nicotinamide, and oral activated charcoal. Conclusions Currently, there are insufficient or conflicting data regarding interventions evaluated in clinical trials for mitigation of vascular calcification in people with CKD. Therapy involving magnesium or sodium thiosulfate appears most promising, but evaluable studies were small and of short duration.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Calcimimeticsmentioning

confidence: 99%

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Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials

Smith

Tiong

et al. 2022

JASN

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“…Furthermore, cholecalciferol improved vascular stiffness in pre-dialysis patients compared to placebo, suggesting a beneficial effect of cholecalciferol on endothelial function [87]. However, treatment with cholecalciferol did not significantly attenuate CAC in CKD [88]. Evidence for a beneficial effect of vitamin D supplementation on CV calcification progression remains uncertain.…”

Section: Vitamin Dmentioning

confidence: 99%

Cardiovascular Calcification in Chronic Kidney Disease—Therapeutic Opportunities

Himmelsbach

Ciliox

Goettsch

2020

Toxins

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Patients with chronic kidney disease (CKD) are highly susceptible to cardiovascular (CV) complications, thus suffering from clinical manifestations such as heart failure and stroke. CV calcification greatly contributes to the increased CV risk in CKD patients. However, no clinically viable therapies towards treatment and prevention of CV calcification or early biomarkers have been approved to date, which is largely attributed to the asymptomatic progression of calcification and the dearth of high-resolution imaging techniques to detect early calcification prior to the ‘point of no return’. Clearly, new intervention and management strategies are essential to reduce CV risk factors in CKD patients. In experimental rodent models, novel promising therapeutic interventions demonstrate decreased CKD-induced calcification and prevent CV complications. Potential diagnostic markers such as the serum T50 assay, which demonstrates an association of serum calcification propensity with all-cause mortality and CV death in CKD patients, have been developed. This review provides an overview of the latest observations and evaluates the potential of these new interventions in relation to CV calcification in CKD patients. To this end, potential therapeutics have been analyzed, and their properties compared via experimental rodent models, human clinical trials, and meta-analyses.

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Vitamin D-Stoffwechsel, Störungen

Ramos-Lopez¹,

Badenhoop²

2020

DGIM Innere Medizin

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The Effect of Long-Term Cholecalciferol Supplementation on Vascular Calcification in Chronic Kidney Disease Patients With Hypovitaminosis D

Cited by 8 publications

References 27 publications

Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials

Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials

Cardiovascular Calcification in Chronic Kidney Disease—Therapeutic Opportunities

Vitamin D-Stoffwechsel, Störungen

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