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Open Access Research article

The influence of vitamin D analogs on calcification modulators, N-terminal pro-B-type natriuretic peptide and inflammatory markers in hemodialysis patients: a randomized crossover study

Ditte Hansen12*, Knud Rasmussen2, Lars M Rasmussen3, Helle Bruunsgaard4 and Lisbet Brandi5

Author Affiliations

1 Department of Nephrology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark

2 Department of Medicine, Roskilde Hospital, Koegevej 7-13, 4000 Roskilde, Denmark

3 Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark

4 Center of Inflammation and Metabolism, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark

5 Department of Medicine, Hillerød Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark

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BMC Nephrology 2014, 15:130  doi:10.1186/1471-2369-15-130

Published: 12 August 2014

Abstract

Background

The risk of cardiovascular disease is tremendously high in dialysis patients. Dialysis patients treated with vitamin D analogs show decreased cardiovascular morbidity and mortality compared with untreated patients. We examined the influence of two common vitamin D analogs, alfacalcidol and paricalcitol, on important cardiovascular biomarkers in hemodialysis patients. Anti-inflammatory effects and the influence on regulators of vascular calcification as well as markers of heart failure were examined.

Methods

In 57 chronic hemodialysis patients enrolled in a randomized crossover trial comparing paricalcitol and alfacalcidol, we examined the changes in osteoprotegerin, fetuin-A, NT-proBNP, hs-Crp, IL-6 and TNF-α, during 16 weeks of treatment.

Results

NT-proBNP and osteoprotegerin increased comparably in the paricalcitol and alfacalcidol-treated groups. Fetuin-A increased significantly in the alfacalcidol-treated group compared with the paricalcitol-treated group (difference 32.84 μmol/l (95% C.I.; range 0.21–67.47)) during the first treatment period. No difference was found between the groups during the second treatment period, and IL-6, TNF-α and hs-Crp were unchanged in both treatment groups.

Conclusions

Paricalcitol and alfacalcidol modulate regulators of vascular calcification. Alfacalcidol may increase the level of the calcification inhibitor fetuin-A. We did not find any anti-inflammatory effect or difference in changes of NT-proBNP.

Trial registry

ClinicalTrials.gov NCT00469599 May 3 2007.

Keywords:
Cardiovascular disease; Heart failure; Hemodialysis; Vascular calcification; Vitamin D