Impact of Vitamin D on Cardiac structure and function in CKD patients with hypovitaminosis D, a randomised controlled trial and meta-analysis.

Abstract

INTRODUCTION\nVitamin D deficiency is associated with cardiovascular events in CKD yet the impact of supplementation is controversial. Previous active vitamin D supplementation studies did not show improvement in cardiac structure or function but the effect of native vitamin D supplementation in CKD patients with low vitamin D levels is unknown. We have addressed this question via both a randomised double-blind prospective study and a meta-analysis of three randomised placebo-controlled studies.\n\n\nMETHODS AND RESULTS\nWe conducted a randomised double-blind, placebo-controlled trial of vitamin D supplementation in stable, non-diabetic, CKD 3-4 patients with circulating vitamin D\u2009<\u200975nmol/L, who were receiving treatment with ACEi or ARB and had high-normal left ventricular (LV) mass. Patients were randomised to receive 6 directly-observed doses of 100,000\u2009IU cholecalciferol (n\u2009=\u200925) or matched placebo (n\u2009=\u200923). The primary endpoint was change in LV Mass index (LVMI) over 52 weeks, as assessed by cardiac magnetic resonance imaging. Secondary endpoints included changes in LV ejection fraction; left and right ventricular volumes and left and right atrial area.Vitamin D concentration increased with the administration of cholecalciferol. The change in LVMI with cholecalciferol (median[interquartile-range], -0.25g[-7.20 to 5.30]) was no different from placebo (-4.30g[9.70 to 2.60]). There was no difference in changes of LV ejection fraction; left and right ventricular volumes and left and right atrial area. The meta-analysis of three 52-week, randomised placebo-controlled studies using active/native vitamin D supplementation showed no differences in LVMI measurements.\n\n\nCONCLUSION\nVitamin D supplementation does not have beneficial effects on left ventricular mass in CKD patients.