Reparative effects of paricalcitol and calcitriol in patients with cardiorenal syndrome and chronic allograft nephropathy

Aim. To study the role of vitamin D in the prevention and treatment of cardio-renal syndrome (CRS), chronic allograft nephropathy (CAN), as well as in the renal and cardiac tissue reparation.
Material and methods. This randomized, blind, placebo-controlled study included 120 vitamin D-deficient Russian and Dutch patients — recipients of asystolic and cadaver donor kidneys. All participants were divided into 4 groups: 28 subjects received paricalcitol (2-4 μg/d); 28 — calcitriol (1-6 μg/d per os); 26 — diet and multivitamins (daily vitamin D consumption of 1200-1800 IU); and 27 — placebo plus controlled diet.
Results. At Day 180, CAN severity reached 1,24 in the paricalcitol group and 1,22 in the calcitriol group, compared to 1,43 and 1,68 in the diet and placebo groups, respectively (p<0,05). Baseline glomerular filtration rate, measured immediately after the transplantation, was changed at Day 180 in all groups (p<0,05). FACS analysis revealed a qualitative induction of SP+ renal epithelial cells and cardiomyocytes at Day 180 (p<0,05). In the paricalcitol, calcitriol, and diet groups, the levels of CD133, CD34, CD73, and CD105 were significantly higher than in the placebo group (p<0,01), which was consistent with renal expression of nuclear vitamin D receptors, NVDR (p<0,05). Circulating stem progenitor cells (SPC) demonstrated a relatively high level of NVDR expression (p<0,05). Hypercalcemia, as one of the most important complications of vitamin D therapy in CAN patients, was observed only in 4 out of 28 participants (14 %) in the calcitriol group (p<0,001). Antihypertensive therapy resulted in the reduction of blood pressure levels, from 180/101 mm Hg at baseline to 143/87, 141/94, 147/102, and 165/101 mm Hg in the respective intervention groups (p<0,01). A decrease in the chronic heart failure functional class (NYHA classification) was also observed. Six months after the transplantation, mean CCS score was 533, 611, 524, and 990 in the respective groups (p<0,05).
Conclusion. Vitamin D is an effective medication for CRS and CAN prevention and treatment, which also stimulates renal and myocardial tissue reparation. In the clinical practice settings, the optimal forms of vitamin D therapy are treatment with an analog of active vitamin D — paricalcitol (204 μg/d), and special diet in combination with multivitamins (up to 1800 IU of cholecalciferol per day).

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