Vitamin D, vitamin D receptor and the importance of its activation in patients with chronic kidney disease

被引:29
作者
Bover, Jordi [1 ]
Egido, Jesus [2 ]
Fernandez-Giraldez, Elvira [3 ]
Praga, Manuel [4 ]
Solozabal-Campos, Carlos [5 ]
Torregrosa, Jose V. [6 ]
Martinez-Castelao, Alberto [7 ]
机构
[1] Fundacio Puigvert, Serv Nefrol, Barcelona 08025, Spain
[2] Univ Autonoma Madrid, Fdn Jimenez Diaz, Serv Nefrol, E-28049 Madrid, Spain
[3] Hosp Arnau Vilanova, Serv Nefrol, Lerida, Spain
[4] Hosp Univ 12 Octubre, Serv Nefrol, Madrid, Spain
[5] Hosp Virgen Camino, Serv Nefrol, Pamplona, Spain
[6] Hosp Clin Barcelona, Serv Nefrol, Barcelona, Spain
[7] Hosp Univ Bellvitge, Serv Nefrol, Barcelona, Spain
来源
NEFROLOGIA | 2015年 / 35卷 / 01期
关键词
Chronic kidney disease; Vitamin D; Vitamin D receptor; Calcitriol; Paricalcitol; Phosphate; Vascular calcification; PATIENTS RECEIVING HEMODIALYSIS; SMOOTH-MUSCLE-CELLS; SECONDARY HYPERPARATHYROIDISM; MINERAL METABOLISM; BONE DISORDER; VASCULAR CALCIFICATION; RENAL OSTEODYSTROPHY; DIALYSIS PATIENTS; PARICALCITOL; CALCITRIOL;
D O I
10.3265/Nefrologia.pre2014.Sep.11796
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Vitamin D deficiency has been linked to many different pathologies, especially with morbimortality in patients with chronic kidney disease. The progressive loss of renal function leads to calcitriol deficiency and homeostatic changes in calcium, phosphate, FGF-23 and PTH, among others. All these changes can also influence vitamin D receptor (VDR) activation and the development of secondary hyperparathyroidism (SHPT). The biologic actions of both vitamin D and its synthetic analogues are mediated by binding to the same VDR, acting on different genes. There is a narrow relationship between low levels of calcitriol and SHPT. The combined approach of VDR activation and phosphate restriction, among others, plays an important role in the early treatment of the chronic kidney disease-mineral and bone disorder (CKD-MBD). The Spanish Society of Nephrology, in order to reduce the uniform and significant association with CKD-associated mortality, calcidiol and high phosphate levels suggests normalization of phosphate as well as calcidiol levels in both CKD and dialysis patients. Moreover, it considers that, in addition to selective/non selective activation of VDR for the prevention and treatment of SHPT, VDR could be activated in dialysis patients by native vitamin D or even low paricalcitol doses, independently of PTH levels, as some cohort studies and a recent metaanalysis have found an association between treatment with active vitamin D and decreased mortality in patients with CKD. In general it is considered reasonable to use all this information to individualise decision making.
引用
收藏
页码:28 / 41
页数:14
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