Background: The incidence of cardiovascular disease in hemodialysis (HD) patients is high. Disorders of the mineral metabolism seem to play a critical role. Epidemiological studies have found an increased survival in HD patients receiving vitamin D receptor analogs (VDRA) and a difference in survival depending on kind of VDRA used. Augmentation index (Aix) and pulse wave velocity (PWV) are strong predictors of cardiovascular mortality in hemodialysis patients. Whether treatment with VDRA influence on Aix and PWV in hemodialysis patients are unknown.

Methods: Eight subjects (6 male) mean(SD) age 74.3(10.4) with secondary hyperparathyroidism receiving chronic hemodialysis therapy were randomised to 16 weeks of treatment with paricalcitol or alfacalcidol (6/2). A wash out period of six weeks preceded the treatment. Aortic stiffness was evaluated with aorticPWV and wave reflections with Aix by applanation tonometri (Sphygmocor) at the beginning and at the end of the treatment period.

Results: Overall treatment with VDRA seemed to decrease heart rate adjusted Aix (−14.2 ± 7.7%, n.s.), PWV were unchanged (0.8 ± 5.1%).

There was a significant difference in the effect of the two VDRA on PWV. Paricalcitol decreased PWV while alfacalcidol increased PWV (−4.9 ± 4.7 vs. 17.6 ± 2.0%; p<0.05). There were not any difference in changes in Aix between paricalcitol treated patients or alfacalcidol treated patients (−13.1 ± 6.4 vs. −17.6 ± 17.4 %; n.s)

Conclusion: VDRA tends to decrease Aix. Paricalcitol improve whereas alfacalcidol worsens PWV. These findings are coherent with present epidemiologic studies. Larger studies are needed to confirm these results.