Pulse Dose versus Continuous Dose of Calciferol on Vascular Stiffness in Diabetic Kidney Disease: A Randomized Trial

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Naphat Wutilertcharoenwong
Korrakot Pornchaichanakit
Tanun Ngamvichchukorn

Abstract




Objective: Vitamin D deficiency is a common condition among chronic kidney disease (CKD) patients. It is associated with cardiovascular mortality. Giving calciferol to CKD patients could help reduce vascular stiffness and decrease the risks of coronary artery disease and mortality. The current recommendation for treating vitamin D deficiency in CKD patients is using the same treatment strategies for the general population. However, there is no recommendation on the exact dose and duration. The purpose of this trial is to compare the effects of pulse dose versus continuous dose of calciferol on vascular stiffness in diabetic kidney patients.


Methods: 31 patients with type 2 diabetes mellitus (T2DM), eGFR 15-59 mL/min/1.73 m2, and 25(OH) D level < 30 ng/mL, were enrolled in this randomized, open-label trial to receive either pulse dose (200,000 IU at the 0th and 8th weeks) or continuous dose (40,000 IU weekly for 8 weeks then 20,000 IU weekly for 2 weeks) of calciferol. The primary outcome was the vascular stiffness measured by the changes in carotid-femoral pulse wave velocity (cfPWV) at 10th week.


Results: The mean 25(OH)D level at the baseline was 18.7 ng/mL in the pulse dose versus 19.9 ng/mL in the continuous dose. In the pulse dose, 10 patients (66.7%) achieved optimal vitamin D level while 6 patients (40%) did in the continuous dose. The mean change of cfPWV between the two groups, which was -0.5 (95%CI -3.15 to 2.15) (p=0.703), was not statistically significant. No adverse effect was reported.


Conclusion: 10 weeks of calciferol given to CKD patients with T2DM and 25(OH)D < 30 ng/mL could achieve a higher reduction of Cardio-ankle vascular index in the pulse dose group than in the continuous dose group. Despite the lack of statistically significant change in Carotid-femoral pulse wave velocity (cfPWV), there seemed to be a higher cfPWV reduction in the pulse dose, with the achievement of 25(OH)D level.




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References

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