RT Journal
A1 Thadhani R, Tamez H, Solomon SD
T1 VItamin d therapy and cardiac function in chronic kidney disease—reply
JF JAMA
JO JAMA
YR 2012
FD June 6
VO 307
IS 21
SP 2253
OP 2253
DO 10.1001/jama.2012.4176
UL http://dx.doi.org/10.1001/jama.2012.4176
AB 
In Reply: Dr Fourtounas and Drs Rajagopalan and Chan highlight the challenge of identifying the most accurate population for a clinical trial. The PRIMO study aimed to evaluate the effect of activated vitamin D analogs in patients otherwise receiving standard of care therapy in 11 different countries worldwide. Therefore, patients who were well treated according to standard clinical practices, which included use of RAAS inhibitors and other blood pressure agents, were enrolled. While these agents themselves may influence left ventricular hypertrophy,1- 2 the conduct of a clinical trial performed on a background of less than standard-of-care therapy would have been unethical, and a positive result from such a trial would have been difficult to interpret. Although paricalcitol did not have an effect on LVMI in patients receiving state-of-the-art care, there was a suggested benefit in other parameters, including cardiovascular hospitalizations, levels of brain natriuretic peptide, and left atrial volume index.