Paricalcitol Reduced Residual Renal Risk in Diabetic Nephropathy Patients

The findings from the VITAL study add to existing data demonstrating the potential antiproteinuric actions of paricalcitol when added to standard therapies, Dr. Merlin C. Thomas and Dr. Mark E. Cooper wrote in an accompanying editorial.

They also underscore the fact that patients with diabetes, and particularly those with chronic kidney disease, "in whom the urinary loss of protein-associated vitamin D magnifies reduced activation of vitamin D by the proximal tubule and reduced expression of the vitamin D receptor," have increased rates of vitamin D deficiency. For these patients it "seems rational to replace vitamin D," they wrote (Lancet 2010[doi:10.1016/S0140-6736(10)61301-3]).

Selective analogues that restore vitamin D receptor-signaling without risking hypercalcemia or hyperphosphatemia – as paricalcitol appears to do in the VITAL study – might be of particular benefit, they said, adding that trials in patients with diabetes "should now test whether such analogues can ultimately improve mortality and cardiovascular outcomes, as suggested in studied of patients with end-stage renal disease."

Dr. Thomas and Dr. Cooper are with the Baker IDI Heart and Diabetes Institute, Melbourne, Australia. Dr. Thomas is also with Monash University in Melbourne. Both reported having no disclosures.