Mineral Metabolism and Vascular Effects of Vitamin D Therapy in Kidney Transplant Patients (PAD)

• ClinicalTrials.gov Identifier: NCT00646282
• Recruitment Status: Terminated
• First Posted: March 28, 2008
• Results First Posted: January 26, 2015
• Last Update Posted: January 26, 2015
• Sponsor: Emory University
• Information provided by (Responsible Party): Antonio Guasch, M.D., Emory University

Study Description

Brief Summary:

Patients with kidney failure on dialysis can be successfully transplanted. However, many of them do not attain a normal kidney function and/or present a slow deterioration of kidney function after transplantation. As a consequence, they can develop an endocrine disorder called hyperparathyroidism, which can cause bone disease and a high risk of bone fractures. In spite of the known bone disease and hyperparathyroidism, there is no well defined treatment for these patients.

Moreover, kidney transplant recipients present a higher mortality rate compared to the general population, and the principal cause of death is cardiovascular disease. Dialysis patients are known to have extensive cardiovascular calcifications and increased vascular stiffness, and these factors have been closely associated with cardiovascular mortality.

The effect of vitamin D on bone health is well known in the general population. Many studies showed a reduction in fracture rate in post-menopausal women and older men receiving vitamin D and calcium supplements. Vitamin D analogues are also commonly used to treat hyperparathyroidism in dialysis patients. Finally, vitamin D has been suggested to have beneficial effects on the cardiovascular system and to reduce mortality in dialysis patients.

Hectorol® is a vitamin D analog which has been demonstrated to effectively treat hyperparathyroidism in dialysis and pre-dialysis patients.

The effects of vitamin D supplementation on bone disease, hyperparathyroidism and cardiovascular function in kidney transplant recipients have not been properly studied.

Whether Hectorol® therapy helps reducing the severity of bone disease and improving vascular function in kidney transplant recipients is still unknown.

Condition or disease	Intervention/treatment	Phase
Hyperparathyroidism, Secondary	Drug: doxercalciferol	Phase 4

Detailed Description:

The investigators plan to study the cardiovascular and bone effects of Hectorol® in 100 kidney transplant recipients. The kidney transplant patients will be screened for kidney transplant dysfunction and hyperparathyroidism. The study medication will be given to 50 patients. The other 50 patients will continue to be treated with the actual standard of care at the transplant clinic. Subjects will be followed for 18 months and their laboratory values, bone density, vascular calcification and stiffness will be collected to see if there is an effect of Hectorol® compared to the actual standard of care.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 12 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Mineral Metabolism and Vascular Effects of Vitamin D Therapy in Kidney
• Study Start Date: April 2008
• Actual Primary Completion Date: January 2010
• Actual Study Completion Date: January 2010

Arms and Interventions

Arm	Intervention/treatment
Experimental: Doxercalciferol; Stable kidney transplant recipients will receive Doxercalciferol	Drug: doxercalciferol; The study drug dosage will be initiated according to baseline iPTH levels. For patients with iPTH>300 pg/ml, oral Doxercalciferol will be given at 1 mcg/day; for patients with iPTH <300 pg/ml, oral Doxercalciferol will be initiated at 0.5 mcg/day.; Other Name: Hectorol
No Intervention: Control; Stable kidney transplant recipients will not receive any drug

Outcome Measures

Primary Outcome Measures :

1. Number of Subjects With 50% Reduction of Intact Parathyroid Hormone (iPTH) Levels [ Time Frame: 18 months ]
   Number of participants that have 50% reduction in iPTH levels (but not lower than 65 pg/ml) at 18 months

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Kidney transplant recipient > 18 year/old with reduced and stable kidney function (estimated GFR 25-60 ml/min/1.73m2)
• iPTH levels between 120 and 500 pg/ml
• Stable immunosuppressive therapy (5-10 mg Prednisone/day, stable dosage of calcineurin inhibitors, or other immunosuppressive agents for at least 6 months)

Exclusion Criteria:

• Recent rejection episode (< 3 months)
• One of the following: baseline estimated GFR>60 ml/min/1.73m2 or <25 ml/min/1.73m2, albumin-corrected Ca>9.5 mg/dl or serum phosphorus >4.6 mg/dl.
• Recipients of dual transplant organs with exception of kidney-pancreas
• Patients already receiving treatment with Vitamin D analogues
• Severe peripheral vascular disease or coronary artery disease
• History of previous parathyroidectomy
• Current alcohol or drug abuse
• Pregnant or nursing woman or female of child-bearing age not receiving contraception
• Other comorbidities that in the opinion of the investigators would reduce expected patient's survival and preclude study completion
• Medications that could interfere with Hectorol® metabolism

Contacts and Locations

Locations

United States, Georgia

Emory University

Atlanta, Georgia, United States, 30322

Sponsors and Collaborators

Emory University

Investigators

• Principal Investigator: Paolo Raggi and Antonio Guasch, MDs; Emory University

More Information

• Responsible Party: Antonio Guasch, M.D., Professor, Emory University
• ClinicalTrials.gov Identifier: NCT00646282
• Other Study ID Numbers: IRB00006614
• First Posted: March 28, 2008
• Results First Posted: January 26, 2015
• Last Update Posted: January 26, 2015
• Last Verified: January 2015

Additional relevant MeSH terms:

Hyperparathyroidism; Hyperparathyroidism, Secondary; Parathyroid Diseases; Endocrine System Diseases; 1 alpha-hydroxyergocalciferol; Vitamins; Micronutrients; Physiological Effects of Drugs; Bone Density Conservation Agents