Effect of active vitamin-D on left ventricular mass index: results of a randomised controlled trial in type 2 diabetes and chronic kidney disease.

BACKGROUND: Active vitamin-D deficiency is a potential modifiable risk factor for increased ventricular mass. We explored the effects of active vitamin-D (calcitriol) treatment on left ventricular mass in patients with type-2 diabetes (T2D) and chronic kidney disease (CKD).

METHODS: We performed a 48-week duration single centre randomised double-blind parallel group trial examining the impact of calcitriol, 0.5 mcg once daily, as compared to placebo on a primary endpoint of change from baseline in left ventricular mass index (LVMI) measured by magnetic resonance imaging (MRI). Patients with T2D, CKD stage-3 and raised left ventricular mass on stable renin angiotensin aldosterone system blockade, who all had elevated intact parathyroid hormone (iPTH) were eligible. Secondary endpoints included interstitial myocardial fibrosis, assessed with cardiac MRI. In total, 45 (male 73%) patients with T2D and stage-3 CKD were studied (calcitriol n=19, placebo n=26).

RESULTS: Following 48-weeks calcitriol treatment, the median difference and the (95% CI) of LVMI between the two treatment arms was 1.84 (-1.28, 4.96), similar between the two groups studied. iPTH fell only in the calcitriol group from 142 pg/ml [80-293] to 76 pg/ml [41-204](p=0.04). No significant differences were observed in interstitial myocardial fibrosis or other secondary endpoints.

CONCLUSIONS: The study did not provide evidence that treatment with calcitriol as compared to placebo might improve LVMI in patients with T2D, mild left ventricular hypertrophy (LVH) and stable CKD. Our data does not support the routine use of active vitamin-D for LVMI regression and cardiovascular protection in patients with T2D and stage-3 CKD.