Paricalcitol for reduction of albuminuria in diabetes.

摘要

We have two issues with the design and presentation of the VITAL trial. First, most patients enrolled in VITAL were vitamin D insufficient (mean 25-hydroxyvitamin D concentration 40-42 nmol/L). The therapeutic or adverse effect pattern might not be extrapolated to patients who are vitamin D sufficient. Thus, we suggest the conclusions be changed to "paricalcitol...safely lowers residual albuminuria in vitamin D insufficient patients with diabetic nephropathy". 25-hydroxyvitamin D insufficiency is associated with adverse outcomes, and vitamin D supplementation decreases inflammation even in dialysis patients, probably through local, auto, or paracrine activity of extrarenal calcitriol generation. Calcitriol protects podo-cytes and has shown antialbuminuric effects in preclinical studies.