A randomized intervention study to evaluate the effect of calcitriol therapy on the renin-angiotensin system in diabetes.

J Renin Angiotensin Aldosterone Syst

1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA.

Published: September 2018

AI Article Synopsis

  • Prior studies suggested that vitamin D therapy might reduce cardiovascular disease risk in type 2 diabetes by lowering activity in the renin-angiotensin system (RAS), but there haven't been many human studies on this yet.
  • This study aimed to see how calcitriol, a vitamin D receptor activator, affects RAS activity and blood flow in individuals with controlled type 2 diabetes who do not have chronic kidney disease.
  • The results showed that while calcitriol increased vitamin D levels, it did not significantly alter RAS activity or blood flow metrics compared to the placebo, indicating no major benefits from this treatment in the studied population.

Article Abstract

Background: Prior studies suggest that vitamin D therapy may decrease cardiovascular disease risk in type 2 diabetes (T2DM) by lowering renin-angiotensin system (RAS) activity. However, randomized human intervention studies to evaluate the effect of vitamin D receptor (VDR) agonists on RAS activity are lacking.

Objective: The objective of this article is to investigate the effect of direct VDR activation with calcitriol on circulating RAS activity and vascular hemodynamics in T2DM.

Methods: A randomized, double-blinded, and placebo-controlled study wherein 18 participants with well-controlled T2DM without chronic kidney disease (CKD) were administered calcitriol or placebo for three weeks was conducted. Outcome measures included plasma renin activity (PRA), serum and urinary aldosterone, mean arterial pressure (MAP) before and after an infusion of angiotensin II, and renal plasma flow (RPF) via para-aminohippurate clearance.

Results: Despite an increase in 1,25(OH)D with calcitriol administration (45.4 to 61.8 pg/ml, p = 0.03) and no change with placebo, there were no significant differences in PRA, serum or urinary aldosterone, baseline and angiotensin II-stimulated MAP, or basal and angiotensin II-stimulated RPF between interventions.

Conclusion: In this randomized and placebo-controlled study in participants with T2DM without CKD, calcitriol therapy to raise 1,25(OH)D levels, when compared with placebo, did not significantly change circulating RAS activity or vascular hemodynamics.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896865PMC
http://dx.doi.org/10.1177/1470320317754178DOI Listing

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