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BMC Nephrology Volume 13 ,Issue 1 ,2012-11-20
Antiproteinuric effect of add-on paricalcitol in CKD patients under maximal tolerated inhibition of renin-angiotensin system: a prospective observational study
Luca De Nicola 1 Giuseppe Conte 2 Domenico Russo 3 Antonio Gorini 4 Roberto Minutolo 2
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Received 2012-07-16, accepted for publication 2012-11-18, Published 2012-11-18

Background Whether paricalcitol (PCT) reduces proteinuria in the presence of intensified inhibition of Renin-Angiotensin-System (RAS) is poorly studied. We evaluated the antiproteinuric effect of PCT in non-dialysis chronic kidney disease (CKD) patients with proteinuria greater than 0.5 g/24 h persisting despite anti-RAS therapy titrated to minimize proteinuria in the absence of adverse effects. Methods Forty-eight CKD patients were studied in the first six months of add-on oral PCT (1 mcg/day) and three months after drug withdrawal. Results Males were 87.5%, age 63 ± 14 yrs, systolic/diastolic blood pressure (BP) 143 ± 22/78 ± 11 mmHg, eGFR 29.7 ± 14.5 mL/min/1.73 m2, diabetes 40%, and cardiovascular disease 38%. At referral in the center (28 months prior to study baseline), proteinuria was 2.44 (95% CI 1.80-3.04) g/24 h with 6 patients not receiving any anti-RAS and 42 treated with a single agent, at low dosage in most cases. At study baseline, twenty patients were under 2–3 anti-RAS drugs while twenty-eight received 1 agent at full dose and proteinuria resulted to be reduced versus referral to 1.23 g/24 h (95%CI 1.00-1.51). Six months of add-on PCT significantly decreased proteinuria to 0.61 g/24 h (95%CI 0.40-0.93), with levels less than 0.5 g/24 h achieved in 37.5% patients, in the absence of changes of BP and GFR. Proteinuria recovered to basal value after drug withdrawal. The extent of antiproteinuric response to PCT was positively associated with diabetes, eGFR and daily Na excretion (R2 = 0.459, P < 0.0001). PTH decreased from 201 (IQR 92–273) to 83 (IQR 50–189) pg/mL. Conclusions In CKD patients, add-on PCT induces a significant reduction of proteinuria that is evident despite intensified anti-RAS therapy and larger in the presence of diabetes, higher GFR and unrestricted salt intake.


Proteinuria; Chronic kidney disease; Paricalcitol; Renin inhibitor; Angiotensin II receptor blocker;Angiotensin converting enzyme inhibitor


2012 De Nicola et al.; licensee BioMed Central Ltd.


Figure 1. Proteinuria levels measured in 42 patients before (baseline), after add-on Paracalcitol (Month 6), and after three-month drug withdrawal. Data are geometric mean and 95% confidence interval. See text (Results) for missing patients.

Table 1.

Table 2.


Luca De Nicola. Cattedra di Nefrologia - Dip. Gerontologia, Geriatria, Mal. Metabolismo, Seconda Università di Napoli, Facoltà di Medicina, Piazza Miraglia, 80131, Napoli, Italia .luca.denicola@unina2.it


Luca De Nicola,Giuseppe Conte,Domenico Russo,Antonio Gorini,Roberto Minutolo. Antiproteinuric effect of add-on paricalcitol in CKD patients under maximal tolerated inhibition of renin-angiotensin system: a prospective observational study. BMC Nephrology ,Vol.13, Issue 1(2012)



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