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Abstract: FR-PO1050

Effects of Vitamin D on Cardiovascular and Renal Outcomes in Adults with CKD: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Yeung, Wing Chi Gigi, St George Hospital, Sydney, New South Wales, Australia
  • Talbot, Ben, University of New South Wales, Sydney, New South Wales, Australia
  • Shah, Nasir A., St George Hospital, Sydney, New South Wales, Australia
  • Palmer, Suetonia, University of Otago, Christchurch, New Zealand
  • Toussaint, Nigel David, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  • Badve, Sunil, St George Hospital, Sydney, New South Wales, Australia
Background

Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease (CKD). The excess risk has been attributed to increased vascular calcification and higher prevalence of left ventricular hypertrophy. Vitamin D therapy plays an important role in management of secondary hyperparathyroidism but may also have cardioprotective effects. This systematic review was performed to study the effects of vitamin D therapy on cardiovascular and renal outcomes.

Methods

MEDLINE, EMBASE and Cochrane databases were searched for randomised controlled trials involving CKD patients stages 3-5D with ≥3 months follow-up that compared a vitamin D compound (nutritional or active) with placebo, no study medication, or an active medication. For continuous variables, the change between the baseline value and end-of-treatment value was calculated. Summary estimates were obtained by a random-effects model and expressed as weighted mean differences (WMD) or relative risks (RR) with 95% confidence intervals (CI).

Results

One hundred and thirteen trials (9973 participants) were included (mean age 60.5 years, median follow-up 6 months). Of these, 71 trials were conducted in 6036 dialysis patients, and 42 trials were conducted in 3937 non-dialysis CKD patients. Trials were generally at high or unclear risk of bias.

There was no significant difference in risk of major adverse cardiovascular outcomes when comparing vitamin D and placebo (11 trials, RR 0.98, 95%CI 0.65-1.48), or active and nutritional vitamin D (2 trials, RR 0.85, 95%CI 0.32-2.31). Compared to placebo, vitamin D did not significantly change systolic blood pressure (7 trials, WMD 0.43 mmHg, 95% CI -3.43 to 4.29), diastolic blood pressure (5 trials, WMD 0.58 mmHg, 95%CI -2.16 to 3.32), pulse wave velocity (4 trials, WMD -0.75 m/sec, 95%CI -1.56 to 0.07), left ventricular mass (4 trials, WMD 2.17 g/m2, 95%CI -8.01 to 12.36) or glomerular filtration rate (11 trials, WMD -0.25 mL/min/1.73m2, 95%CI -0.78 to 0.29). Data for B-natriuretic peptide levels and urine albumin/creatinine ratio were insufficient for meta-analysis.

Conclusion

The effects of vitamin D compounds on cardiovascular and renal outcomes in CKD are uncertain. Further research with adequately powered trials is required.