Andress Dennis L
Department of Medicine, VA Puget Sound Health Care System and Department of Medicine, University of Washington, Seattle, Washington 98108, USA.
Semin Dial. 2005 Jul-Aug;18(4):315-21. doi: 10.1111/j.1525-139X.2005.18408.x.
Activated vitamin D continues to be the major treatment for suppressing parathyroid hormone (PTH) levels in dialysis patients who have secondary hyperparathyroidism. Active vitamin D compounds are distinguished by their ability to bind with high affinity to vitamin D receptors (VDRs) not only in the parathyroid glands, but in cells throughout the body. Because of recent data showing that pulsatile, intravenous vitamin D treatment (calcitriol or paricalcitol) confers a survival advantage in the dialysis population, there is new interest in understanding the systemic effects of VDR activation, particularly in the predialysis stages of chronic kidney disease (CKD), where high mortality rates from cardiovascular disease have recently been documented. Previous underutilization of calcitriol treatment to control PTH levels in stages 3 and 4 CKD was often due to concerns about its potential for accelerating the progression of CKD as a consequence of hypercalcemia, hypercalciuria, or hyperphosphatemia. Vitamin D analogs with selective VDR activity (such as paricalcitol) have great potential for preventing parathyroid hyperplasia and bone loss in early CKD without adversely affecting kidney function. Whether they also reduce cardiovascular morbidity and mortality in early CKD, as they appear to do in dialysis patients, remains to be determined.
活性维生素D仍然是治疗继发性甲状旁腺功能亢进的透析患者甲状旁腺激素（PTH）水平的主要方法。活性维生素D化合物的特点是它们不仅能与甲状旁腺中的维生素D受体（VDR）高亲和力结合，还能与全身细胞中的VDR高亲和力结合。由于最近的数据表明，脉冲式静脉注射维生素D治疗（骨化三醇或帕立骨化醇）在透析人群中具有生存优势，因此人们对了解VDR激活的全身效应产生了新的兴趣，特别是在慢性肾脏病（CKD）的透析前阶段，最近有文献记载该阶段心血管疾病死亡率很高。以前在CKD 3期和4期未充分利用骨化三醇治疗来控制PTH水平，通常是因为担心其可能因高钙血症、高钙尿症或高磷血症而加速CKD的进展。具有选择性VDR活性的维生素D类似物（如帕立骨化醇）在早期CKD中预防甲状旁腺增生和骨质流失方面具有很大潜力，且不会对肾功能产生不利影响。它们是否也能像在透析患者中那样降低早期CKD的心血管发病率和死亡率，仍有待确定。
