Vitamin D Supplementation in Diabetic Nephropathy

NCT ID: NCT01476501

Last Updated: 2022-08-31

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 120 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-10-31
• Study Completion Date: 2015-12-31

Brief Summary

Diabetes is a life-long disease that is getting more common in Canada. One of the most common problems in people with kidney disease is diabetes and low bone mineral density (BMD). This can lead to a higher chance for broken bones, infection and life-long health problems. The most common reason for having low BMD is not getting enough vitamin D (Vit D) in your diet and not having enough sunlight. This is very common in Canada (especially in northern Alberta) because winter is very long. Most people also don't eat or drink enough foods that are high in Vit D (like milk) and so they don't have enough Vit D in their body to make healthy bones. This can mean the only way to get enough Vit D in your body for your bones when you have kidney disease is to take some extra vitamin D in a pill. Most people are not aware that they have poor bone health until they break a bone. Broken bones can really hurt and can prevent a person from being able to walk and take care of themselves. Right now, we are not sure exactly how much Vit D people with diabetes and kidney disease need to take to prevent them from having low BMD or how often they need to take it. Our plan is to study the effect of two ways to take Vit D pills (every day or once a month) on overall Vit D status and on bone health in adult patients with diabetes and chronic kidney disease and see how this influences their quality of life.

Hypotheses:

1. Vitamin D supplementation (2,000 IU/day and 40,000 IU/month) for six months will result in significantly improved overall vitamin D status and improved markers of bone health in adult patients with diabetic nephropathy.

2. Monthly dosing of vitamin D (40,000 IU/month) over six months will result in improved patient adherence and satisfaction with vitamin D supplementation when compared to daily dosing of vitamin D (2000 IU/D). This will improve vitamin D status and bone health parameters, which will result in an increased quality of life and sense of well-being.

Detailed Description

Abstract:

Vitamin D has a well-established role in bone health and the prevention of fractures which are associated with increased morbidity and mortality, and reduced quality of life. However, many individuals have sub-optimal vitamin D status (<75nmol/l), and risk increases with geographical location, age, ethnicity, inadequate dietary intake and disease. Diabetes and kidney disease are two chronic diseases associated with both poor bone health and suboptimal vitamin D status. Individuals with diabetes and chronic kidney disease who live in northern Alberta are at a particular risk for suboptimal vitamin D status and poor bone health due to dietary restrictions on vitamin D rich foods (e.g. milk products that are also high in phosphorus and carbohydrates), negligible cutaneous synthesis during the long winter months, and reduced renal capacity to synthesize active vitamin D (1,25(OH)2D). In the general Canadian population, few are able to meet dietary recommendations for vitamin D intake through diet alone and often rely on vitamin D supplements. The need for vitamin D supplementation is increased in diabetics with nephropathy, however the optimal dose and strategy for vitamin D supplementation is unknown. Like other chronic diseases, adherence to therapy is a major issue in this population. With each additional chronic disease an individual has, their adherence to therapy and quality of life decreases. Adherence to vitamin D therapy is known to be particularly poor. This may be related to the silent nature of bone disease, as poor bone health is often not identified until a fracture has occurred. Novel strategies to vitamin D supplementation are needed to prevent poor bone health and fractures, and the resulting decline in quality of life that ensues. Therefore it is important to identify a vitamin D supplementation strategy that increases adherence to vitamin D supplementation and improves vitamin D status and bone health in adults with diabetes and nephropathy.

Objectives:

• Examine the impact of two approaches to oral high dose vitamin D supplementation (2,000 IU/day versus 40,000 IU/month for six months) on overall vitamin D status and markers of bone turnover in adult patients with diabetic nephropathy.
• Examine daily versus monthly vitamin D supplementation strategies in regards to adherence, satisfaction and quality of life in adult patients with diabetic nephropathy.

Hypotheses:

1. Vitamin D supplementation (2,000 IU/day and 40,000 IU/month) for six months will result in significantly improved overall vitamin D status and improved markers of bone health in adult patients with diabetic nephropathy.

2. Monthly dosing of vitamin D (40,000 IU/month) over six months will result in improved patient adherence and satisfaction with vitamin D supplementation when compared to daily dosing of vitamin D (2000 IU/D). This will improve vitamin D status and bone health parameters, which will result in an increased quality of life and sense of well-being.

Conditions

Sub-optimal Vitamin D Status; Bone Disease; Diabetic Nephropathy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

2,000 IU/day vitamin D

2,000 IU/day vitamin D for 6 months (n=60).

Group Type: EXPERIMENTAL

Vitamin D3

Intervention Type: DRUG

Randomized into 1 of 2 oral vitamin D3 softgel capsule supplementation strategies: 1) 2,000 IU/day (2 x 1,000IU/capsule each day) or 2) 40,000 IU/month (4 x 10,000IU/capsule last day of each month), for 6 months each.

40,000 IU/month vitamin D

40,000 IU/month for 6 months (n=60).

Group Type: EXPERIMENTAL

Vitamin D3

Intervention Type: DRUG

Randomized into 1 of 2 oral vitamin D3 softgel capsule supplementation strategies: 1) 2,000 IU/day (2 x 1,000IU/capsule each day) or 2) 40,000 IU/month (4 x 10,000IU/capsule last day of each month), for 6 months each.

Interventions

Vitamin D3

Randomized into 1 of 2 oral vitamin D3 softgel capsule supplementation strategies: 1) 2,000 IU/day (2 x 1,000IU/capsule each day) or 2) 40,000 IU/month (4 x 10,000IU/capsule last day of each month), for 6 months each.

Intervention Type: DRUG

Other Intervention Names

Daily: Jamieson NPN 80017530; Monthly: EURO-Pharm DIN 02253178

Eligibility Criteria

Inclusion Criteria

• Clinical diagnoses of diabetes (type 1 or 2) and stage 2-4 chronic kidney disease (glomerular filtration rate: 15-89 ml/min/1.73m2)

Exclusion Criteria

• Patients with co-morbid conditions known to affect vitamin D metabolism including gastrointestinal, liver, rheumatoid or bone disorders (e.g. hyperthyroidism, untreated celiac disease, cancer, Paget's disease, sarcoidosis, malabsorption, etc). Individuals with severe, permanent vision impairment will be excluded as this will preclude them from reading supplement labels accurately and safely. Pregnant women will be excluded as DXA scans are not recommended during pregnancy. Patients weighing >136kg will be excluded as the DXA table cannot accommodate this weight.
• Patients on drug therapy known to interfere with vitamin D (e.g. oral glucocorticoids, cholestyramine, colestipol, mineral oil, Orlistat, digoxin, antacids).
• Patients with stage 5 CKD (GFR <15ml/min/1.73m2), receiving dialysis or on kidney transplant list.
• Patients with pre-existing hypercalcemia (>2.75mmol/l), hyperphosphatemia (>2.0mmol/l), severe hyperparathyroidism (PTH >600pg/ml), and serum 25(OH)D >200nmol/l.
• Patients with serum 25(OH)D <37.5nmol/l at time of study entry/screening to control for correction of vitamin D deficiency.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Alberta

OTHER

Sponsor Role: lead

Responsible Party

dmager

Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Diana R Mager, PhD RD

Role: PRINCIPAL_INVESTIGATOR

University of Alberta

Peter A Senior, MBBS PhD

Role: PRINCIPAL_INVESTIGATOR

University of Alberta

Locations

Clinical Research Unit, University of Alberta

Edmonton, Alberta, Canada

Countries

Canada

References

Mager DR, Jackson ST, Hoffmann MR, Jindal K, Senior PA. "Vitamin D supplementation and bone health in adults with diabetic nephropathy: the protocol for a randomized controlled trial". BMC Endocr Disord. 2014 Aug 12;14:66. doi: 10.1186/1472-6823-14-66.

Reference Type: BACKGROUND

PMID: 25115438 (View on PubMed)

Mager DR, Jackson ST, Hoffmann MR, Jindal K, Senior PA. Vitamin D3 supplementation, bone health and quality of life in adults with diabetes and chronic kidney disease: Results of an open label randomized clinical trial. Clin Nutr. 2017 Jun;36(3):686-696. doi: 10.1016/j.clnu.2016.05.012. Epub 2016 Jun 2.

Reference Type: RESULT

PMID: 27302208 (View on PubMed)

Other Identifiers

diabetes vitamin D 20112012

Identifier Type: -

Identifier Source: org_study_id