A pilot study of active vitamin D administration and insulin resistance in African American patients undergoing chronic hemodialysis.

Abstract

OBJECTIVE:

Insulin resistance (IR) is associated with increased cardiovascular risk in multiple patient populations, including those undergoing chronic hemodialysis (CHD). Active vitamin D deficiency has been proposed to play a role in the extent of IR observed in patients with CHD. We postulated that administration of paracalcitol, an active vitamin D medication, influences IR in patients with CHD.

DESIGN AND METHODS:

This was a pilot randomized controlled trial. Ten prevalent CHD patients receiving a stable dose of paracalcitol were recruited. Paracalcitol was withheld for 8 weeks in all patients (phase I). Parathyroid hormone levels were managed with the calcium-sensing receptor agonist cinacalcet. At week 8, patients were randomized to continue cinacalcet or to restart paracalcitol for 8 weeks (phase II). The primary outcome was the change in IR measured by the glucose disposal rate (GDR) using hyperinsulinemic euglycemic clamp (HEGC) method. Secondary outcomes included changes in IR between groups in indirect indices of IR, biomarkers of inflammation, and adipokine levels.

RESULTS:

The mean age was 49 years (range, 46-57 years) and 40% of patients were women. There was no detectable change in the GDR at the end of phase I (P = .7) when compared with baseline values. There was also no statistically significant difference in GDR between groups at the end of phase II (P = .9). No changes were observed in indirect indices of IR, adipokine levels, or biomarkers of inflammation in either phase.

CONCLUSION:

The results of this pilot study suggest that withdrawal of paracalcitol over 8 to 16 weeks and replacement for 8 weeks after withdrawal does not influence IR measured by HEGC in patients receiving CHD.

• Authors: Adriana M Hung, Mary B Sundell, Natalia E Plotnikova, Aihua Bian, Ayumi Shintani, Charles D Ellis, Edward D Siew, T Alp Ikizler
• Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation (J Ren Nutr) Vol. 23 Issue 3 Pg. 185-93 (May 2013) ISSN: 1532-8503 [Electronic] United States
• PMID: 22959781 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Published by Elsevier Inc.

Chemical References

• Adipokines
• Biomarkers
• Naphthalenes
• Parathyroid Hormone
• Receptors, Calcium-Sensing
• Vitamin D
• Cinacalcet

Topics

• Absorptiometry, Photon
• Adipokines (blood)
• Black or African American
• Biomarkers (blood)
• Body Composition
• Cardiovascular Diseases (epidemiology)
• Chronic Disease
• Cinacalcet
• Double-Blind Method
• Endpoint Determination
• Female
• Glucose Clamp Technique
• Humans
• Hyperinsulinism (epidemiology)
• Inflammation (complications)
• Insulin Resistance
• Kidney Failure, Chronic (complications, drug therapy)
• Male
• Middle Aged
• Naphthalenes (pharmacology)
• Parathyroid Hormone (blood)
• Pilot Projects
• Receptors, Calcium-Sensing (agonists, metabolism)
• Renal Dialysis
• Risk Factors
• Vitamin D (administration & dosage)
• Vitamin D Deficiency (complications, drug therapy)