Paricalcitol supplementation during the first year after kidney transplantation does not affect calcification propensity score

Amin Ussif, Hege Pihlstrøm, Andreas Pasch, Hallvard Holdaas, Anders Hartmann, Knut Smerud, Anders Åsberg, Amin Ussif, Hege Pihlstrøm, Andreas Pasch, Hallvard Holdaas, Anders Hartmann, Knut Smerud, Anders Åsberg

Abstract

Background: Cardiovascular complications are common in kidney transplant patients and calcification propensity of blood, measured as T50, is associated with cardiovascular outcomes. Paricalcitol supplementation affects calcium/phosphate homeostasis and may affect calcification propensity. To assess this hypothesis we measured T50 in kidney transplant recipients participating in a randomized study comparing paricalcitol versus no treatment during the first year after kidney transplantation.

Methods: Stored serum samples from 76 kidney transplant recipients (paricalcitol n = 37, no treatment n = 39) were analyzed. Analyses were performed at inclusion (8 weeks after transplantation) and repeated one year after transplantation.

Results: There were no statistically significant differences in T50 between the paricalcitol and placebo groups, neither at baseline (p = 0.56) nor at 1 year (p = 0.61). Also, there were no significant changes in T50 over time in either group or when pooling all data (p < 0.20). In multivariate regression analysis, out of 16 potentially relevant covariates, comprising clinical and biochemical parameters, only plasma PTH and T50 at baseline were significantly correlated to T50 after one year. (p < 0.03 and p < 0.01, respectively).

Conclusions: Calcium propensity measured as T50 score remained unchanged with paricalcitol treatment in kidney transplant recipients, and was not changed over time during the study period of one year.

Trial registration: ClinicalTrials.gov, NCT01694160 , registered 23 September 2012.

Keywords: Calcification propensity score; Paricalcitol; Randomized controlled trial; Renal transplantation.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Regional Ethics Committee for the Oslo region (Health region south-east). All participants gave their written informed consent before any study-associated investigations were performed.

Consent for publication

Not applicable.

Competing interests

AP is the inventor of the T50 test, and holds stock in Calciscon AG, Berne, Switzerland, the company that markets the T50 test. All other authors declare no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Mean T50 (min) after renal transplantation (paricalcitol vs placebo)

References

    1. Matsushita K, van der Velde M, Astor BC, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073–2081. doi: 10.1016/S0140-6736(10)60674-5.
    1. Schlieper G, Schurgers L, Brandenburg V, Reutelingsperger C, Floege J. Vascular calcification in chronic kidney disease: an update. Nephrol Dial Transplant. 2016;31(1):31–39. doi: 10.1093/ndt/gfv111.
    1. Jono S, Shioi A, Ikaria Y, et al. Vascular calcification in chronic kidney disease. J Bone Miner Metab. 2006;24:176–181. doi: 10.1007/s00774-005-0668-6.
    1. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38:938–942. doi: 10.1161/hy1001.096358.
    1. Hernandez D, Rufino M, Bartolomei S, et al. Clinical impact of pre-existing vascular calcfications on mortality rate after renal transplantation. Kidney Int. 2005;67:2015–2020. doi: 10.1111/j.1523-1755.2005.00303.x.
    1. Amer H, Griffin MD, Stegall MD, et al. Oral paricalcitol reduces the prevalence of posttransplant hyperparathyroidism: results of an open label randomized trial. Am J Transplant. 2013;13:1576. doi: 10.1111/ajt.12227.
    1. Trillini M, Cortinovis M, Ruggenenti P, et al. Paricacitol for secondary hyperparathyroidism in renal transplantation. J Am Soc Nephrol. 2015;26(5):1205–1214. doi: 10.1681/ASN.2013111185.
    1. Hadjiyannakos D, Filiopoulos V, Trompouki S, et al. Treatment with oral paricalcitol in daily clinical practice for patients with chronic kidney disease stage 3-4: a preliminary study. Clin Kidney J. 2013;6:164. doi: 10.1093/ckj/sfs188.
    1. Cozzolino M, Brancaccio D. Emerging role for the vitamin D receptor activator (VDRA), paricalcitol, in the treatment of secondary hyperparathyroidism. Expert Opin Pharmacother. 2008;9:947. doi: 10.1517/14656566.9.6.947.
    1. Pihlstrøm HK, Gatti F, Hammarström C. Early introduction of oral paricalcitol in renal transplant recipients. An open-label randomized study. Transpl Int. 2017;30:2612–2620. doi: 10.1111/tri.12973.
    1. Pasch A, Farese S, Grabver S, et al. Nanoparticle-based test measures overall propensity for calcification in serum. J Am Soc Nephrol. 2012;23:1744–1752. doi: 10.1681/ASN.2012030240.
    1. Smith ER, Ford ML, Tomlinson LA, et al. Serum calcification propensity predicts all-cause mortality in predialysis CKD. J Am Soc Nephrol. 2014;25(2):339–348. doi: 10.1681/ASN.2013060635.
    1. .Pasch A, Block GA, Bachtler M et al. Blood calcification propensity, cardiovascular events, and survival in patients receiving hemodialysis in the EVOLVE trial. Clin J Am Soc Nephrol 2017 Feb 7;12(2):315–322. 10.2215/CJN.04720416. Epub 2016 Dec 9.
    1. Keyzer CA, de Borst MH, van den Berg E, et al. Calcification Propensity and Survival among Renal Transplant Recipients. J Am Soc Nephrol. 2016;27(1):239–248. doi: 10.1681/ASN.2014070670.
    1. Dahle DO, Åsberg A, Hartmann A, et al. Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients. Am J Transplant. 2016;16(1):204–212. doi: 10.1111/ajt.13443.
    1. Smerud KT, Åsberg A, Kile HA. rapid and sustained improvement of calcification propensity score (serum T50 ) after successful kidney transplantation: Reanalysis of a randomized controlled trial of ibandronate. Clin Transpl. 2017;31(12):e13131. doi: 10.1111/ctr.13131.

Source: PubMed

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