To investigate whether treatment with a vitamin-D receptor activator is able to improve important markers of cardiovascular risk.
Main question: May 12 weeks of VDRA treatment reduce the pathological sympathetic overactivation associated with moderate kidney disease? Secondary questions aim to thrown light on how VDRAs can reduce albuminuria and CRP, i.e. does VDRA treatment improve (prespecified statistical analyses): A) diastolic dysfunction? B) capillary microcirculation, and whether ameliorated disturbances relate to improved diastolic dysfunction? C) endothelial dysfunction and arterial stiffness? D) inflammatory activation? E) platelet function and haemostasis? F) levels of antibacterial peptides? G) levels of IGFBP-1 and adiponectin? Overall design The study is designed as a double-blind, randomised, placebo-controlled trial involving two groups (n=72) of patients: 1) chronic kidney failure (CKD, eGFR 15-59 mL/m2) and 2) chronic kidney failure and concomitant diabetes mellitus (CKD+DM). It will start with a two-week placebo run-in, followed by randomisation to: 1. Zemplar 1 μg (taken as 1 x 1 μg capsule and one placebo capsule), 2. Zemplar 2 μg (taken as 2 x 1 μg capsules) and 3. placebo (taken as two placebo capsules).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
36
Vitamin D receptor activator (VDRA)
Karolinska Institute at Danderyd University Hospital
Danderyd, Stockholm County, Sweden
A significant reduction in muscle sympathetic nerve activity (MSNA) measured by means of microneurography.
Sympathetic activation is closely related to severity and progression of cardiovascular diseases, and renovascular dysfunction. We will directly measure sympathetic activation using microneurography (muscle sympathetic nerve activity; MSNA), expressed as bursts/minute and bursts/100 RR-interval. As this is a physiological study, the primary outcome will constitute a significant reduction in MSNA.
Time frame: Measured after 12 weeks treatment.
Microcirculatory function measured by laser doppler methods.
Assessed by skin laser-doppler methodology, and directly by nailfold capillaroscopy.
Time frame: Measured after 12 weeks treatment.
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