Vitamin D Supplementation in Kidney Disease

Sponsor
VA Office of Research and Development (U.S. Fed)
Overall Status
Active, not recruiting
CT.gov ID
NCT01229878
Collaborator
(none)
45
1
2
133
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Study Details

Study Description

Brief Summary

This is a double-blind placebo controlled pilot study to determine if vitamin D supplementation in hemodialysis (HD) patients will improve physical function and cognition. HD patients have a high prevalence of vitamin D deficiency, cognitive impairment, and physical impairment. Despite standard clinical care with active IV vitamin D during dialysis, HD patients still have markedly low levels of nutritional or dietary vitamin D. IV treatment with vitamin D during dialysis is aimed at treating HD related bone disease. Recent literature shows that oral or nutritional vitamin D has multiple extra-skeletal effects including improvement in cognition and physical function. In this study, the investigators plan to administer oral vitamin D to vitamin D deficient HD patients already receiving standard care with IV vitamin D therapy. Patients will be randomized to receive either placebo or 50,000 IU of vitamin D (cholecalciferol) weekly for 6 months. The investigators' specific aims are to 1) Assess the benefits of correcting nutritional vitamin D deficiency on cognitive and physical function in HD patients receiving routine standard of care, 2) Assess the feasibility of recruiting HD patients for this study, and 3) Evaluate the proposed regimen for safely and effectively increasing nutritional vitamin D levels with oral supplementation. The investigators anticipate that correction of nutritional vitamin D deficiency to optimal levels will improve the high prevalence of cognitive impairment and physical impairment in this population. These results will be used as evidence to support a larger study aimed at treating nutritional vitamin D deficiency in all patients receiving HD. These results may also contribute to a change in current guidelines which place little emphasis on the monitoring and treatment of nutritional vitamin D levels in HD patients. These results are important for the Veteran dialysis population since many of them are required to perform high-level cognitive tasks such as management of complex medical regimens and physical tasks such as orchestrating independent transportation to and from HD sessions and multiple physician appointments.

Condition or Disease Intervention/Treatment Phase
  • Dietary Supplement: Cholecalciferol (Vitamin D)
N/A

Detailed Description

Patients will first be identified based on the inclusion criteria, then informed about the study and consented. Those who meet the exclusion criteria will be randomized to treatment or placebo. Enrolled participants will be randomized 2:1 to receive vitamin D (n=20) or placebo (n=10) for 6 months. All participants will be tested twice over two weeks to establish baseline values. Following baseline testing, the treatment group will receive 50,000 IU (standard replacement therapy) of oral cholecalciferol or placebo. The initial dose of cholecalciferol will be 50,000 IU weekly for 6 weeks. Vitamin D levels will then be measured. Participants who still have Vitamin D insufficiency ( 35 ng/ml) will remain on 50,000 IU of cholecalciferol for another 6 weeks, at which point Vitamin D levels will be measured again. Participants who reach 25-OH levels > 35 ng/ml will have their dosing regimen lessened to 10,000 IU weekly (maintenance dose) for the remainder of the 6 months. Participants receiving placebo will start taking the placebo maintenance dose after the first 6 weeks. For safety monitoring, 25(OH) vitamin D3 levels will also be re-measured at monthly intervals and followed by an independent medical monitor. In patients who have serum vitamin D levels 60ng/ml, the frequency of administration will be reduced to once a month. The participants will receive supplementation for a total of 6 months. At this time, vitamin D levels will be reassessed and participants will undergo follow-up functional assessments, and cognitive and immune testing.

Study Design

Study Type:
Interventional
Actual Enrollment :
45 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
Vitamin D Supplementation on Physical and Cognitive Function-Pilot Study
Actual Study Start Date :
Dec 1, 2011
Anticipated Primary Completion Date :
Jun 30, 2022
Anticipated Study Completion Date :
Dec 30, 2022

Arms and Interventions

Arm Intervention/Treatment
Active Comparator: Arm 1

Hemodialysis Patients randomized to take Vitamin D supplements

Dietary Supplement: Cholecalciferol (Vitamin D)
50,000 units of cholecalciferol or a placebo pill administered once a week for 6 months

Placebo Comparator: Arm 2

Hemodialysis Patients randomized to take placebo pills

Dietary Supplement: Cholecalciferol (Vitamin D)
50,000 units of cholecalciferol or a placebo pill administered once a week for 6 months

Outcome Measures

Primary Outcome Measures

  1. Neuromuscular Function [6 months]

    strength testing of hip flexors and extensors

Secondary Outcome Measures

  1. Quality-of-Life self assessment [6 months]

    questionnaire of physical/medical health

  2. Neuropsychological assessments [6 months]

    battery of neurocognitive tests

  3. Immune Function assessments [6 months]

    assay of immunity markers

Eligibility Criteria

Criteria

Ages Eligible for Study:
45 Years to 89 Years
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • Receiving HD for at least two weeks

  • Receiving IV vitamin D supplementation according to National Kidney Foundation guidelines.

  • Male or female with an between the ages of 45-89 years

  • Veteran outpatient or stable community living center patient

  • Able to ambulate independently or with an assistive device for at least 20 feet

Exclusion Criteria:
  • 25-OH vitamin D level < 25 ng/ml

  • Hypercalcemia

  • Active malignancy within 6 months

  • Receiving intravenous antibiotics for infection

  • History of Dementia

  • Hemoglobin < 8.5g

  • History of conditions that interfere with postural instability (e.g. cerebellar disease, vestibular disease or any others that may present)

  • Poor compliance with dialysis treatments (history of skipping 2 treatments per month for > 2 months)

Contacts and Locations

Locations

Site City State Country Postal Code
1 James J. Peters VA Medical Center, Bronx, NY Bronx New York United States 10468

Sponsors and Collaborators

  • VA Office of Research and Development

Investigators

  • Principal Investigator: James B Post, MD, James J. Peters Veterans Affairs Medical Center

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
VA Office of Research and Development
ClinicalTrials.gov Identifier:
NCT01229878
Other Study ID Numbers:
  • F7539-P
First Posted:
Oct 28, 2010
Last Update Posted:
Mar 25, 2022
Last Verified:
Mar 1, 2022
Individual Participant Data (IPD) Sharing Statement:
No
Plan to Share IPD:
No
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Product Manufactured in and Exported from the U.S.:
No
Additional relevant MeSH terms:

Study Results

No Results Posted as of Mar 25, 2022