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Vitamin D and Coronary Calcification Study (VCOR)

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ClinicalTrials.gov Identifier: NCT00752102
Recruitment Status : Completed
First Posted : September 15, 2008
Results First Posted : December 8, 2017
Last Update Posted : December 8, 2017
Sponsor:
Collaborator:
Abbott
Information provided by (Responsible Party):
Joslin Diabetes Center

September 11, 2008
September 15, 2008
August 24, 2017
December 8, 2017
December 8, 2017
September 2008
October 2013   (Final data collection date for primary outcome measure)
Coronary Artery (CAC) Score Progression [ Time Frame: 48 weeks ]

coronary artery (CAC) score difference between baseline and followup CT scans. It was measured in Agatston units. These are units of amount of calcification in the blood vessels so it's a continuous variable. The amount of calcium was quantified with the Agatston scoring method. Calcium scores were adjusted with a standard calcium phantom that was scanned along with the participant. The phantom contained known calcium density bars and provided a way to calibrate the x-ray attenuation level.

Participants scoring CAC >400 are considered to be at risk for having at least one coronary lesion.

To determine prospectively if there is a differential effect on coronary artery (CAC) score progression between calcitriol and paricalcitol in patients with chronic kidney disease. [ Time Frame: Baseline and week 48 ]
Complete list of historical versions of study NCT00752102 on ClinicalTrials.gov Archive Site
Not Provided
  • To determine prospectively if there is a differential effect on aortic and valvular score progression and arterial stiffness in patients with chronic kidney disease receiving calcitriol and paricalcitol. [ Time Frame: Baseline and week 48 ]
  • To determine prospectively if there is a differential effect on biomarkers of vascular calcification and mineral metabolism in patients with chronic kidney disease receiving calcitriol and paricalcitol. [ Time Frame: Baseline and week 48 ]
Not Provided
Not Provided
 
Vitamin D and Coronary Calcification Study
A Phase IV, Randomized, Single-center Study of the Effects of Calcitriol and Paricalcitol on Vascular Calcification in Chronic Kidney Disease Stages 3 and 4

Patients with chronic kidney disease (CKD) have a higher mortality rate than the general population, with cardiovascular disease (CVD) accounting for approximately 50% of deaths. Vascular calcification is a common finding in patients with CKD. Furthermore, patients with CKD develop secondary hyperparathyroidism, partly because of a decrease of calcitriol synthesis on the kidney. Treatment of secondary hyperparathyroidism includes use of activated vitamin D including calcitriol and paricalcitol. Recent evidence in dialysis patients suggest an improved survival in patients using paricalcitol compared to calcitriol.

Studies in uremic rats suggests that there are differential effects of calcitriol and paricalcitol in expression of markers of soft-tissue calcification independent of calcium-phosphorus product. Calcitriol increased calcification of vascular smooth muscle cells cultured in calcification media. There was also significant increase in pulse pressure in animals treated with calcitriol.

The investigators hypothesize that these different forms of vitamin D may have differential effects in vascular calcification progression in CKD patients.

Coronary artery calcification (CAC) is a risk marker for CVD and mortality. In animal models, calcitriol significantly increased the serum calcium-phosphate product and aortic calcium content, while paricalcitol had no effect. The objective of this randomized, blinded single-center is to determine the differential effect of oral calcitriol and paracalcitol on vascular calcification in patients with chronic kidney disease (CKD).

We performed a total of 89 screening visits and randomized 44 participants. Forty participants completed the final visit. Diagram 1 presents the recruitment schematic.

Interventional
Phase 4
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
  • Chronic Kidney Disease
  • Vitamin D Deficiency
  • Coronary Calcification
  • Disorders of Calcium and Bone Metabolism
  • Drug: Calcitriol (Rocaltrol®)
    Subjects taking calcitriol will be started at 0.25 mcg 3x/week and titrated up during the next visit according to PTH levels. If at the 12 week visit, PTH is still not at goal, then calcitriol will be increased to 0.5 mcg 3x/week.
    Other Names:
    • Calcijex®
    • Rocaltrol®
  • Drug: Paricalcitol
    Subjects taking paricalcitol will be started at 2 mcg 3x/week and titrated up during the next visit according to PTH levels. If at the 12 week visit, PTH is still not at goal, then paricalcitol will be increased to 4 mcg 3x/week.
    Other Name: Zemplar®
  • Active Comparator: Calcitriol

    Calcitriol is a synthetic vitamin D analog which is active in the regulation of the absorption of calcium from the gastrointestinal tract and its utilization in the body. Calcitriol is available as capsules containing 0.25 mcg or 0.5 mcg calcitriol and as an oral solution containing 1 mcg/ml of calcitriol. All dosage forms contain butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT) as antioxidants.

    Subjects taking calcitriol started at 0.25 mcg 3x/week and titrated up during the next visit according to PTH levels.

    Intervention: Drug: Calcitriol (Rocaltrol®)
  • Active Comparator: Paricalcitol

    Paricalcitol, USP, the active ingredient in Zemplar® Capsules, is a synthetically manufactured analog of calcitriol, the metabolically active form of vitamin D indicated for the prevention and treatment of secondary hyperparathyroidism in chronic kidney disease. Zemplar is available as soft gelatin capsules for oral administration containing 1 mcg, 2 mcg or 4 mcg of paricalcitol. Each capsule also contains medium chain triglycerides, alcohol, and butylated hydroxytoluene.

    Subjects taking paricalcitol will be started at 2 mcg 3x/week and titrated up during the next visit according to PTH levels.

    Intervention: Drug: Paricalcitol
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
44
October 2013
October 2013   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • CKD stages 3 or 4 (estimated glomerular filtration rate (eGFR) between 15 and 59)
  • Diagnosis of secondary hyperparathyroidism, which is defined as:

    • Elevated intact PTH (iPTH) as per KDIGO guidelines:

      • CKD stage 3 (eGFR 30-59) or CKD stage 4 (eGFR 15-29) with iPTH > Upper Limit of Normal for lab (6.8 pmol/L)
  • Presence of Coronary Artery Calcium (CAC > 0)
  • Subject will be able to complete the study, to the best of his/her knowledge

Exclusion Criteria:

  • iPTH >1500 pg/ml
  • Current or previous use of bisphosphonates
  • History of parathyroidectomy or anticipated parathyroidectomy
  • History of cinacalcet use
  • History of a solid organ transplant or scheduled date for transplant surgery
  • History of coronary revascularization (coronary artery bypass surgery or percutaneous intervention)
  • History of coronary artifact (e.g. pacemaker, intracardiac defibrillator, artificial valve or biventricular leads)
  • Active atrial fibrillation
  • Weight greater than 300 pounds (due to limitations of equipment)
  • HIV positive
  • Current pregnancy (although pregnancy is very rare in the CKD population)
  • Life expectancy less than two years as judged by primary physician
  • Institutionalized patients (nursing home or prisoners)
  • Language barrier or mental incapacity to consent
  • Inability to swallow tablets or current gastrointestinal disorder that may be associated with impaired absorption of orally administered medications.
Sexes Eligible for Study: All
25 Years and older   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT00752102
Abbott #20128
No
Not Provided
Not Provided
Joslin Diabetes Center
Joslin Diabetes Center
Abbott
Principal Investigator: Sylvia E Rosas, MD, MSCE Joslin Diabetes Center
Joslin Diabetes Center
December 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP