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Treating endothelial dysfunction with vitamin D in chronic kidney disease: a meta-analysis.
BMC Nephrol. 2018 09 25; 19(1):247.BN

Abstract

BACKGROUND

Vitamin D deficiency is common in patients with chronic kidney disease (CKD), and is associated with endothelial dysfunction and cardiovascular disease. We performed a meta-analysis to assess the effect of vitamin D treatment on flow mediated vasodilation (FMD) in CKD patients.

METHODS

PubMed/Medline, Web of Science, Embase and Cochrane trials and reviews were searched systematically for randomized controlled trials (RCT:s) using any vitamin D compound, at any stage of CKD, with FMD as outcome. Fixed and random effects models were performed using the standardized mean difference effect size post treatment for each trial. Heterogeneity was assessed by I2 statistics.

RESULTS

4 trials were included, comprising 305 patients. One used both 1 and 2 μg for two intervention groups and was therefore split in two during the analysis. Patients in the included trials had a mean age of 44-65 years and were all in CKD 3 to 4. One study used cholecalciferol, the others all used paricalcitol as treatment. Study duration was 12-16 weeks. Intervention with vitamin D was associated with ameliorated FMD (STANDmean ES 0.78, 95% CI 0.55-1.01) in a fixed model. Heterogeneity was substantial (I2 = 84%). Secondary analysis with random model analysis also showed significant results.

CONCLUSIONS

Short term intervention with vitamin D is associated with improvements in endothelial function, as measured by FMD. This indicates positive effects of vitamin D on vascular disease in CKD. Limitations of this meta-analysis are the small number of studies performed, and the short duration of intervention.

Authors+Show Affiliations

Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden. kristina.lundwall@sll.se. Department of Cardiology, Danderyd University Hospital, 182 88, Stockholm, Sweden. kristina.lundwall@sll.se.Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden. Department of Cardiology, Danderyd University Hospital, 182 88, Stockholm, Sweden.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

30253741

Citation

Lundwall, Kristina, et al. "Treating Endothelial Dysfunction With Vitamin D in Chronic Kidney Disease: a Meta-analysis." BMC Nephrology, vol. 19, no. 1, 2018, p. 247.
Lundwall K, Jacobson SH, Jörneskog G, et al. Treating endothelial dysfunction with vitamin D in chronic kidney disease: a meta-analysis. BMC Nephrol. 2018;19(1):247.
Lundwall, K., Jacobson, S. H., Jörneskog, G., & Spaak, J. (2018). Treating endothelial dysfunction with vitamin D in chronic kidney disease: a meta-analysis. BMC Nephrology, 19(1), 247. https://doi.org/10.1186/s12882-018-1042-y
Lundwall K, et al. Treating Endothelial Dysfunction With Vitamin D in Chronic Kidney Disease: a Meta-analysis. BMC Nephrol. 2018 09 25;19(1):247. PubMed PMID: 30253741.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treating endothelial dysfunction with vitamin D in chronic kidney disease: a meta-analysis. AU - Lundwall,Kristina, AU - Jacobson,Stefan H, AU - Jörneskog,Gun, AU - Spaak,Jonas, Y1 - 2018/09/25/ PY - 2018/06/14/received PY - 2018/09/10/accepted PY - 2018/9/27/entrez PY - 2018/9/27/pubmed PY - 2019/9/11/medline KW - Cholecalciferol KW - Endothelial function KW - Flow mediated vasodilation KW - Paricalcitol KW - Renal failure SP - 247 EP - 247 JF - BMC nephrology JO - BMC Nephrol VL - 19 IS - 1 N2 - BACKGROUND: Vitamin D deficiency is common in patients with chronic kidney disease (CKD), and is associated with endothelial dysfunction and cardiovascular disease. We performed a meta-analysis to assess the effect of vitamin D treatment on flow mediated vasodilation (FMD) in CKD patients. METHODS: PubMed/Medline, Web of Science, Embase and Cochrane trials and reviews were searched systematically for randomized controlled trials (RCT:s) using any vitamin D compound, at any stage of CKD, with FMD as outcome. Fixed and random effects models were performed using the standardized mean difference effect size post treatment for each trial. Heterogeneity was assessed by I2 statistics. RESULTS: 4 trials were included, comprising 305 patients. One used both 1 and 2 μg for two intervention groups and was therefore split in two during the analysis. Patients in the included trials had a mean age of 44-65 years and were all in CKD 3 to 4. One study used cholecalciferol, the others all used paricalcitol as treatment. Study duration was 12-16 weeks. Intervention with vitamin D was associated with ameliorated FMD (STANDmean ES 0.78, 95% CI 0.55-1.01) in a fixed model. Heterogeneity was substantial (I2 = 84%). Secondary analysis with random model analysis also showed significant results. CONCLUSIONS: Short term intervention with vitamin D is associated with improvements in endothelial function, as measured by FMD. This indicates positive effects of vitamin D on vascular disease in CKD. Limitations of this meta-analysis are the small number of studies performed, and the short duration of intervention. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/30253741/Treating_endothelial_dysfunction_with_vitamin_D_in_chronic_kidney_disease:_a_meta_analysis_ L2 - https://www.biomedcentral.com/1471-2369/19/247 DB - PRIME DP - Unbound Medicine ER -