The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2014-01, Vol.29 (1), p.97-109
• Main Authors: Molina, Pablo, Górriz, José L, Molina, Mariola D, Peris, Ana, Beltrán, Sandra, Kanter, Julia, Escudero, Verónica, Romero, Ramón, Pallardó, Luis M
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Albuminuria - etiology; Albuminuria - prevention & control; Cholecalciferol - therapeutic use; Dietary Supplements; Disease Progression; Female; Humans; Hyperparathyroidism - drug therapy; Male; Middle Aged; Parathyroid Hormone - blood; Phosphates - blood; Prospective Studies; Renal Insufficiency, Chronic - complications; Vitamin D - blood; Vitamin D Deficiency - drug therapy; Vitamins - therapeutic use; Young Adult
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gft360

Growing evidence indicates that vitamin D receptor activation may have antiproteinuric effects. We aimed to evaluate whether vitamin D supplementation with daily cholecalciferol could reduce albuminuria in proteinuric chronic kidney disease (CKD) patients. This 6-month prospective, controlled, intervention study enrolled 101 non-dialysis CKD patients with albuminuria. Patients with low 25(OH) vitamin D [25(OH)D] and high parathyroid hormone (PTH) levels (n = 50; 49%) received oral cholecalciferol (666 IU/day), whereas those without hyperparathyroidism (n = 51; 51%), independent of their vitamin D status, did not receive any cholecalciferol, and were considered as the control group. Cholecalciferol administration led to a rise in mean 25(OH)D levels by 53.0 ± 41.6% (P < 0.001). Urinary albumin-to-creatinine ratio (uACR) decreased from (geometric mean with 95% confidence interval) 284 (189-425) to 167 mg/g (105-266) at 6 months (P < 0.001) in the cholecalciferol group, and there was no change in the control group. Reduction in a uACR was observed in the absence of significant changes in other factors, which could affect proteinuria, like weight, blood pressure (BP) levels or antihypertensive treatment. Six-month changes in 25(OH)D levels were significantly and inversely associated with that in the uACR (Pearson's R = -0.519; P = 0.036), after adjustment by age, sex, body mass index, BP, glomerular filtration rate and antiproteinuric treatment. The mean PTH decreased by -13.8 ± 20.3% (P = 0.039) only in treated patients, with a mild rise in phosphate and calcium-phosphate product [7.0 ± 14.7% (P = 0.002) and 7.2 ± 15.2% (P = 0.003), respectively]. In addition to improving hyperparathyroidism, vitamin D supplementation with daily cholecalciferol had a beneficial effect in decreasing albuminuria with potential effects on delaying the progression of CKD.