Effect of paricalcitol on renin and albuminuria in non-diabetic stage III-IV chronic kidney disease: a randomized placebo-controlled trial.
Effect of paricalcitol on renin and albuminuria in non-diabetic stage III-IV chronic kidney disease: a randomized placebo-controlled trial.
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DOI：
10.1186/1471-2369-14-163
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发表时间：
2013-07-26
期刊：
影响因子：
2.3
通讯作者：
Pedersen EB
中科院分区：
文献类型：
--
作者：
Larsen T;Mose FH;Bech JN;Pedersen EB
维生素D受体激活剂可减少蛋白尿，并可改善慢性肾病（CKD）患者的生存率。动物研究表明，维生素D的这些多效性作用可能是通过抑制肾素介导的。然而，人类的随机试验尚未建立这种关系。在一项随机、安慰剂对照、双盲交叉研究中，在26例非糖尿病、白蛋白尿III-IV期CKD患者中研究了口服帕立骨化醇（2 μg/天）的作用。治疗结束后测定血浆肾素（PRC）、血管紧张素II（AngII）和醛固酮（Aldo）浓度。通过51 Cr-EDTA清除率测定GFR。通过输注NG-单甲基-L-精氨酸（L-NMMA）评估肾脏NO依赖性。在24小时尿液和51 Cr-EDTA清除期间分析白蛋白排泄率（AER）。帕立骨化醇未改变血浆肾素、AngII、Aldo水平或尿钠和钾排泄。在AER中观察到临界显著性适度降低，帕立骨化醇消除了对L-NMMA的白蛋白尿反应。在这项随机、安慰剂对照试验中，帕立骨化醇仅略微降低AER，且未改变循环中的肾素、AngII或Aldo水平。在NOS阻断期间，帕立骨化醇消除了白蛋白排泄的增加，这可能表明肾脏NO依赖性的有利调节可能参与介导CKD的肾脏保护和生存获益。ClinicalTrials.gov标识符：NCT 01136564
Vitamin D receptor activators reduce albuminuria, and may improve survival in chronic kidney disease (CKD). Animal studies suggest that these pleiotropic effects of vitamin D may be mediated by suppression of renin. However, randomized trials in humans have yet to establish this relationship. In a randomized, placebo-controlled, double-blinded crossover study, the effect of oral paricalcitol (2 μg/day) was investigated in 26 patients with non-diabetic, albuminuric stage III-IV CKD. After treatment, plasma concentrations of renin (PRC), angiotensin II (AngII) and aldosterone (Aldo) were measured. GFR was determined by 51Cr-EDTA clearance. Assessment of renal NO dependency was performed by infusion of NG-monomethyl-L-arginine (L-NMMA). Albumin excretion rate (AER) was analyzed in 24-h urine and during 51Cr-EDTA clearance. Paricalcitol did not alter plasma levels of renin, AngII, Aldo, or urinary excretion of sodium and potassium. A modest reduction of borderline significance was observed in AER, and paricalcitol abrogated the albuminuric response to L-NMMA. In this randomized, placebo-controlled trial paricalcitol only marginally decreased AER and did not alter circulating levels of renin, AngII or Aldo. The abrogation of the rise in albumin excretion by paricalcitol during NOS blockade may indicate that favourable modulation of renal NO dependency could be involved in mediating reno-protection and survival benefits in CKD. ClinicalTrials.gov identifier: NCT01136564
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影响因子：
13.6
作者：
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作者：
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