Abstract
The effects of i.v. 1,25-dihydroxycholecalciferol (DHCC) on blood pressure and insulin sensitivity were studied in 7 patients on maintenance hemodialysis and compared with 7 healthy controls. Three days after discontinuing oral 1,25-DHCC, the dialysis patients were evaluated by glucose clamp studies to quantitate insulin sensitivity, with (+D) and without (−D) a prior single dose of i.v. 1,25-DHCC at 2μg/m2. Blood pressure was measured just before the glucose studies. During −D studies, the patients were hypertensive (mean arterial blood pressure 108±2 mmHg, controls 84±4 mmHg,P<0.02) and insulin resistant (insulin sensitivity index 7.5±0.4 mg/kg·min per μU per ml, controls 14.2±0.7,P<0.01) i.v. 1,25-DHCC significantly reduced the mean arterial blood pressure (96±3 mmHg,P<0.05) and increased insulin sensivity (10.9±0.5 mg/kg·min per μU per ml,P<0.02) in the dialysis patients. I. V. 1,25-DHCC did not change blood pressure and insulin sensitivity in the control subjects. During −D studies, serum concentrations of 1,25-DHCC were significantly lower in patients than controls (P<0.02). Serum 1,25-DHCC during the +D studies increased to supraphysiological levels in both patients and controls. Serum concentrations of intact parathyroid hormone, total and ionized calcium, magnesium, potassium, urea nitrogen and creatinine were not different between the +D and −D studies in either the dialysis patients or the controls. These results suggest that pharmacological doses of 1,25-DHCC may have therapeutic value in the treatment of hypertension and insulin resistance in dialysis patients.
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References
McCarron DA (1982) Lower serum ionized calcium concentration in human hypertension. N Engl J Med 307:226–228
McCarron DA, Pingree PA, Rubin RJ, Gaucher SM, Molitch M, Krutzik S (1980) Enhanced parathyroid function in essential hypertension: a homeostasis response to a urinary calcium leak. Hypertension 2:162–168
Young EW, Dolney AM, McCarron DA, Morris CD (1988) Serum 1,25-(OH)2vitamin D3 in essential hypertension. Am J Hypertens 1:75A
Lucas PA, Brown RC, Dreuke T, Lacour B, Metz JA, McCarron DA (1986) Abnormal vitamin D metabolism, intestinal calcium transport and bone status in the spontaneously hypertensive rat compared with its genetic control. J Clin Invest 78:221–227
Lind L, Lithell H, Skarfors A, Wide L, Ljunghall S (1988) Reduction or blood pressure by treatment with alpha-calciferol. A double-blind placebo-controlled study in subjects with impaired glucose tolerance. Acta Med Scand 223:211–217
Ferrannini E, Buzzigoli G, Bonnadonna R, Antonietta Giorico M, Oleggini M, Graziadei L, Pedrinelli R, Brandi L, Bevilacqua S (1987) Insulin resistance in essential hypertension. N Engl J Med 317:350–357
Hwang IS, Ho H, Hoffman B, Reaven G (1987) Fructose-induced insulin resistance and hypertension in rats. Hypertension 10: 512–516
Reaven GM, Ho H, Hoffman BB (1988) Fructose-induced insulin resistance and hypertension in rats. Hypertension 12:129–132
DeFronzo RA, Tobin JD, Rowe JW, Andres R (1978) Glucose intolerance in uremia: quantification of beta cell sensitivity to insulin. J Clin Invest 62:425–432
Mak RHK, Bettinelli A, Turner C, Haycock GB, Chantler C (1985) The influence of hyperparathyroidism on glucose metabolism in uremia. J Clin Endocrinol Metab 60:229–233
Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S (1985) Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 76:370–373
Nyoma BL, Bouillon R, Bidingija M, Kanjingu K, De Moor P (1986) Vitamin D metabolites and their binding protein in adult diabetic patients. Diabetes 35:911–915
Cade C, Norman AW (1987) Rapid normalization/stimulation by 1,25 dihydroxy-vitamin D3 of insulin secretion and glucose tolerance in the vitamin D deficient rat. Endocrinology 120:1490–1497
Resnick LM, Laragh JH, Sealey JE, Alderman MH (1983) Divalent cations in essential hypertension: relations between serum ionized calcium, magnesium and plasma renin activity. N Engl J Med 309: 888–891
Hellstrom J, Birke G, Edvall CA (1958) Hypertension in hyper-parathyroidism. Br J Urol 30:13–24
Grobbee DE, Hackeng WHL, Birkenhager JC, Hofman A (1986) Intact parathyroid hormone (I-84) in primary hypertension. Clin Exp Hypertens [A]8:299–308
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Mak, R.H.K. Amelioration of hypertension and insulin resistance by 1,25-dihydroxycholecalciferol in hemodialysis patients. Pediatr Nephrol 6, 345–348 (1992). https://doi.org/10.1007/BF00869730
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DOI: https://doi.org/10.1007/BF00869730