Efectos pleiotrópicos del tratamiento combinado con colecalciferol-carbonato cálcico sobre microalbuminuria y proteinuria en pacientes con enfermedad renal crónica estadio iiib-iv

Introduction

We performed a descriptive, retrospective study of 99 patients with stage iiib-iv chronic kidney disease (CKD) receiving calcium plus vitamin D for secondary hyperparathyroidism (SHPT).

Objectives

The main aim of this study was to evaluate reductions in microalbuminuria and proteinuria as a pleiotropic effect of treatment. A secondary aim was to analyze whether renal function, PTH values, and calcium x phosphorus product reached values recommended by guidelines.

Results

We included 99 patients with a mean age 74.8±10 years (60% women and 40% men). The most frequent cause of CKD was nephrosclerosis in 35% of the patients, unknown in 25%, chronic interstitial kidney disease in 22%, diabetes in 15%, and congenital causes in 2%. A total of 50% were receiving angiotensin converting-enzyme inhibitors, 59% were receiving angiotensin receptor blockers, and 10% direct renin inhibitors. Diabetes was present in 34% and hypertension in 92%.

The mean duration of treatment was 430.85 days. The mean changes from baseline values to those at the end of the study were as follows: creatine phosphate: from 2.151 to 2.27 (P=.005); 24-hour urinary creatinine clearance corrected for body surface area: from 33±17 ml/min/1.70 m to 32 ml/min (NS): estimated glomerular filtration rate based on the modification of diet in renal disease (MDRD) formula: from 7: 28.7 ml/min to 28.1 ml/min (NS); creatinine clearance estimated by the Cockroft-Gault formula: from 29 to 28 ml/min (NS); microalbuminuria: from 352.4 to 318.3 mg/day (NS); proteinuria: from 0.63 to 0.62 (NS); and albumin/creatinine ratio: from 651±1.3 to 615±1.1 mg/g (NS).

In diabetic patients, values were as follows: microalbuminuria: from 542 to 432 mg/day (P<.037); proteinuria: from 1 to 0,8 g/24 h (P<.044); corrected calcium: from 9.5 to 9.6 (P<.004); phosphorus levels: from 3.5±0.5 to 3.6±0.6 (NS); PTH levels: from 187 to 143 pg/ml (P<.0001). Calcium × phosphorus product was 33 34.5 mg²/dl² (NS).

Conclusion

Calcium and vitamin D supplementation in patients with stage iiib-iv CKD in addition to effective control of SHPT in diabetic patients reduced microalbuminuria and proteinuria independently of the action of antihypertensive medication and blood pressure control.