Division of Nephrology, Washington University, School of Medicine Saint Louis, MO, USA.
Ther Clin Risk Manag. 2006 Sep;2(3):297-301. doi: 10.2147/tcrm.2006.2.3.297.
Secondary hyperparathyroidism (SHPT) is commonly seen in patients with chronic kidney disease (CKD). Even in early CKD, parathyroid hormone (PTH) levels are elevated, maintaining mineral homeostasis at the cost of long-term bone health. One potent stimulus for PTH secretion is a deficiency of active vitamin D. Replacement with calcitriol, the active form of vitamin D, lowers PTH but often raises calcium and phosphorus levels, predisposing patients to an increased risk of ectopic calcifications. Paricalcitol is a vitamin D analog designed to treat SHPT without raising serum calcium and phosphorus levels. The intravenous preparation of paricalcitol is used routinely in the hemodialysis population and has demonstrated a survival benefit over calcitriol in hemodialysis patients. A new oral preparation has now been developed for use in the pre-dialysis CKD population. Thus far, oral paricalcitol has been shown to reduce PTH by an average of 42% in CKD patients, while having minimal effects on serum calcium and phosphorus. While long term effects of the oral preparation have yet to be studied, emerging evidence suggests that paricalcitol mediates a variety of beneficial effects through the activation of vitamin D receptors which may result in improved survival.
继发性甲状旁腺功能亢进症（SHPT）在慢性肾脏病（CKD）患者中很常见。即使在早期 CKD 中，甲状旁腺激素（PTH）水平也会升高，以牺牲长期骨骼健康为代价维持矿物质内环境稳定。PTH 分泌的一个有力刺激因素是活性维生素 D 的缺乏。用活性维生素 D 的骨化三醇替代，可降低 PTH，但往往会升高钙和磷水平，使患者面临异位钙化风险增加。帕立骨化醇是一种维生素 D 类似物，旨在治疗 SHPT 而不升高血清钙和磷水平。帕立骨化醇的静脉制剂在血液透析人群中常规使用，并已证明在血液透析患者中比骨化三醇具有生存获益。现在已经开发出一种新的口服制剂用于透析前 CKD 人群。到目前为止，口服帕立骨化醇已被证明可使 CKD 患者的 PTH 平均降低 42%，而对血清钙和磷的影响最小。虽然口服制剂的长期效果尚未得到研究，但新出现的证据表明，帕立骨化醇通过激活维生素 D 受体介导多种有益作用，从而可能导致生存率提高。
