Original InvestigationPathogenesis and Treatment of Kidney DiseaseOral Calcitriol for Reduction of Proteinuria in Patients With IgA Nephropathy: A Randomized Controlled Trial
Section snippets
Study Participants
Patients with biopsy-confirmed IgA nephropathy were enrolled from the IgA follow-up team in Peking University Institute of Nephrology. Patients 18 years and older with persistent proteinuria with protein excretion >0.8 g/d after optimal blood pressure control and full RAS inhibition for at least 3 months (in 3 consecutive samples monthly, and the last value was used as baseline calculation), eGFR (calculated by using the 4-variable MDRD [Modification of Diet in Renal Disease] Study equation19)
Demographic Data
Of 164 patients screened for eligibility, 50 were enrolled. All patients finished at least one visit after baseline. Four of these patients completed only 2-5 study visits. Three women became pregnant during the study period, and one of these women (in the calcitriol-treated group) discontinued treatment. All 3 patients discontinued ACE-inhibitor and ARB treatment after confirmation of the pregnancy. These 7 patients were included in the analysis (Fig 1). Baseline demographic, clinical, and
Discussion
In this randomized controlled trial of 50 patients, it was observed that treatment with 2 doses (0.5 μg) of calcitriol per week (with at least 3 days between 2 doses) for 48 weeks decreased proteinuria in patients with IgA nephropathy who were on stable doses of ACE inhibitors and/or ARBs, even in patients with dual inhibition of the RAS by a combination of ACE inhibitors and ARBs. Furthermore, this study showed that patients treated with calcitriol had a substantially greater likelihood of a
Acknowledgements
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
References (30)
Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome
Semin Nephrol
(2004)- et al.
Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial
Am J Kidney Dis
(2009) - et al.
Combined vitamin D analog and AT1 receptor antagonist synergistically block the development of kidney disease in a model of type 2 diabetes
Kidney Int
(2010) - et al.
Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL Study): a randomised controlled trial
Lancet
(2010) - et al.
Oral calcitriol for the treatment of persistent proteinuria in immunoglobulin A nephropathy: an uncontrolled trial
Am J Kidney Dis
(2008) - et al.
Oral paricalcitol in the treatment of patients with CKD and proteinuria: a randomized trial
Am J Kidney Dis
(2009) Histologic subclassification of IgA nephropathy: a clinicopathologic study of 244 cases
Am J Kidney Dis
(1997)- et al.
Antiproteinuric effect of oral paricalcitol in chronic kidney disease
Kidney Int
(2005) - et al.
Suppression of renin-angiotensin gene expression in the kidney by paricalcitol
Kidney Int
(2008) - et al.
Reduction of the vitamin D hormonal system in kidney disease is associated with increased renal inflammation
Kidney Int
(2008)
The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents
Trends Mol Med
Effect of 1,25(OH)2 vitamin D3 on glomerulosclerosis in subtotally nephrectomized rats
Kidney Int
Retarding progression of chronic renal disease: the neglected issue of residual proteinuria
Kidney Int
The commonest glomerulonephritis in the world: IgA nephropathy
Q J Med
Natural history of immunoglobulin A nephropathy and predictive factors of prognosis: a long-term follow up of 204 cases in China
Nephrology (Carlton)
Cited by (77)
Vitamin D Therapy in Adults With CKD: A Systematic Review and Meta-analysis
2023, American Journal of Kidney DiseasesSynergic Interaction of Vitamin D Deficiency and Renal Hyperfiltration on Mortality in Middle-Aged Men
2022, Journal of Renal NutritionExpression of renal vitamin D receptors and metabolizing enzymes in IgA nephropathy
2021, Acta HistochemicaAntiproteinuria Effect of Calcitriol in Patients With Chronic Kidney Disease and Vitamin D Deficiency: A Randomized Controlled Study
2020, Journal of Renal NutritionCitation Excerpt :Our finding, that the degree of proteinuria was lessened after supplementation with an active vitamin D analog in addition to use of a RAAS inhibitor, is consistent with those of the VITAL study.23 Our patients had lower baseline uPCRs than did those in the VITAL study.23,48 This may be because vigorous effort was made to select the optimal treatment for BP, including RAAS inhibitor administration.
Protective effect of calcitriol on podocytes in spontaneously hypertensive rat
2018, Journal of the Chinese Medical AssociationCitation Excerpt :At the same time, emerging clinical and animal studies have demonstrated that active vitamin D and its analogues can attenuate glomerular damage and tubular interstitial fibrosis.8 Treatment with 1,25-dihydroxy-vitamin D (1,25(OH)2D3 or calcitriol) or activated vitamin D analogues reduced albuminuria and prevented podocyte injury in a subtotal nephrectomy model,9,10 puromycin-induced nephropathy,11,12 adriamycin-induced nephropathy,11,13 diabetic nephropathy,3,14,15 immunoglobulin A nephropathy,16,17 and in CKD patients.18,19 However, the mechanism of the antiproteinuric effect of vitamin D remains unknown.
Originally published online October 24, 2011.
Trial registration: ClinicalTrials.gov; study number: NCT00862693.