Vitamin D receptor activation and left ventricular hypertrophy in advanced kidney disease.
BACKGROUND
In chronic kidney disease (CKD), left ventricular hypertrophy (LVH) is prevalent and is associated with increased cardiovascular morbidity and mortality. Vitamin D receptor (VDR) activation attenuates LVH progression in animal models.


METHODS
PRIMO is a multinational, randomized, double-blinded trial with oral paricalcitol in subjects with stages 3-4 CKD, mild-to-moderate LVH and an LV ejection fraction >50%. The primary endpoint is change in the left ventricular mass index (LVMI) compared with placebo after 48 weeks of treatment. The main secondary endpoints are changes in diastolic function parameters. In this paper, we report baseline characteristics from this study.


RESULTS
LVMI was 33.0 ± 7.5 g/m(2.7) for males and 30.8 ± 7.2 g/m(2.7) for females (p = 0.04). LVMI correlated with systolic blood pressure (r = 0.24), urine albumin creatinine ratio (r = 0.39), troponin T (r = 0.29), high-sensitivity C-reactive protein (r = 0.25) and plasma levels of B-type brain natriuretic peptide (r = 0.22); all p < 0.01. In multiple linear regression, each remained independently associated with LVMI. The early diastolic velocity of the lateral mitral annulus (E') was 8.1 ± 2.4 cm/s. E' was inversely correlated with age in univariate (r = -0.14, p = 0.04) and multivariable (p = 0.02) analysis.


CONCLUSIONS
Among 227 multinational subjects with stages 3-4 CKD, baseline LVMI correlates with baseline blood pressure, urine albumin creatinine ratio and cardiac biomarkers, and baseline diastolic function correlates with age. This research was funded by Abbott Laboratories; ClinicalTrials.gov No. NCT00497146.
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, USA. thadhani.r@mgh.harvard.edu
Ravi
R
Thadhani
Evan
E
Appelbaum
Yuchiao
Y
Chang
Yili
Y
Pritchett
Ishir
I
Bhan
Rajiv
R
Agarwal
Carmine
C
Zoccali
Christoph
C
Wanner
Donald
D
Lloyd-Jones
Jorge
J
Cannata
Taylor
T
Thompson
Paul
P
Audhya
Dennis
D
Andress
Wuyan
W
Zhang
Jun
J
Ye
David
D
Packham
Bhupinder
B
Singh
Daniel
D
Zehnder
Warren J
WJ
Manning
Ajay
A
Pachika
Scott D
SD
Solomon
D000284:Administration, Oral; D000368:Aged; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000096:biosynthesis; D003404:Creatinine / Q000652:urine; D004311:Double-Blind Method; D004452:Echocardiography; D004872:Ergocalciferols / Q000008:administration & dosage; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology*; D007674:Kidney Diseases / Q000378:metabolism* / Q000473:pathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018167:Receptors, Calcitriol / Q000378:metabolism*; D013997:Time Factors; D020107:Troponin T / Q000097:blood
D004872:Ergocalciferols; D018167:Receptors, Calcitriol; D020107:Troponin T; C084656:paricalcitol; D002097:C-Reactive Protein; D003404:Creatinine