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Deprecated: Implicit conversion from float 259.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Am+Soc+Nephrol 2017 ; 28 (4): 1296-305 Nephropedia Template TP
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Effects of Vitamin D Receptor Activation and Dietary Sodium Restriction on Residual Albuminuria in CKD: The ViRTUE-CKD Trial #MMPMID27856633
Keyzer CA; van Breda GF; Vervloet MG; de Jong MA; Laverman GD; Hemmelder MH; Janssen WM; Lambers Heerspink HJ; Kwakernaak AJ; Bakker SJ; Navis G; de Borst MH; Keyzer CA; van Breda GF; Vervloet MG; de Jong MA; Laverman GD; Hemmelder MH; Janssen WM; Lambers Heerspink HJ; Kwakernaak AJ; Bakker SJ; Navis G; de Borst MH
J Am Soc Nephrol 2017[Apr]; 28 (4): 1296-305 PMID27856633show ga
Reduction of residual albuminuria during single?agent renin-angiotensin-aldosterone blockade is accompanied by improved cardiorenal outcomes in CKD. We studied the individual and combined effects of the vitamin D receptor activator paricalcitol (PARI) and dietary sodium restriction on residual albuminuria in CKD. In a multicenter, randomized, placebo (PLAC)?controlled, crossover trial, 45 patients with nondiabetic CKD stages 1?3 and albuminuria >300 mg/24 h despite ramipril at 10 mg/d and BP<140/90 mmHg were treated for four 8-week periods with PARI (2 ?g/d) or PLAC, each combined with a low-sodium (LS) or regular sodium (RS) diet. We analyzed the treatment effect by linear mixed effect models for repeated measurements. In the intention-to-treat analysis, albuminuria (geometric mean) was 1060 (95% confidence interval, 778 to 1443) mg/24 h during RS + PLAC and 990 (95% confidence interval, 755 to 1299) mg/24 h during RS + PARI (P=0.20 versus RS + PLAC). LS + PLAC reduced albuminuria to 717 (95% confidence interval, 512 to 1005) mg/24 h (P<0.001 versus RS + PLAC), and LS + PARI reduced albuminuria to 683 (95% confidence interval, 502 to 929) mg/24 h (P<0.001 versus RS + PLAC). The reduction by PARI beyond the effect of LS was nonsignificant (P=0.60). In the per-protocol analysis restricted to participants with ?95% compliance with study medication, PARI did provide further albuminuria reduction (P=0.04 LS + PARI versus LS + PLAC). Dietary adherence was good as reflected by urinary excretion of 174±64 mmol Na+ per day in the combined RS groups and 108±61 mmol Na+ per day in the LS groups (P<0.001). In conclusion, moderate dietary sodium restriction substantially reduced residual albuminuria during fixed dose angiotensin?converting enzyme inhibition. The additional effect of PARI was small and nonsignificant.