Cozzolino Mario, Brancaccio Diego
University of Milan, S. Paolo Hospital, Renal Division, Via A di Rudinì, 8 - 20142, Milan, Italy.
Expert Opin Pharmacother. 2008 Apr;9(6):947-54. doi: 10.1517/14656566.9.6.947.
Secondary hyperparathyroidism (SHPT) is common in chronic kidney disease (CKD) patients. Classically, SHPT is induced by hypocalcemia, hyperphosphatemia, and calcitriol deficiency, that cause not only renal osteodystrophy but also systemic toxicity, particularly cardiovascular disease.
Treatment with calcitriol, the active form of vitamin D, reduces serum parathyroid hormone (PTH) levels but may result in both hypercalcemia and hyperphosphatemia, increasing the risk of vascular calcification in CKD. Are the new vitamin D receptor activators (VDRAs) more useful in the treatment of SHPT for their reduced risk of hypercalcemia and hyperphosphatemia in haemodialysis (HD) patients?
In this review, we describe the new VDRA, paricalcitol (1,25-dihydroxy-19-nor-vitamin D2), which suppresses PTH secretion with minimal increases on serum calcium and phosphate levels.
RESULTS/CONCLUSIONS: In some animal models of CKD paricalcitol does not cause vascular calcification, while other VDRAs do. These data may account for the results seen in observational studies of HD patients, in which paricalcitol is associated with improved survival compared to calcitriol.
继发性甲状旁腺功能亢进（SHPT）在慢性肾脏病（CKD）患者中很常见。传统上，SHPT由低钙血症、高磷血症和骨化三醇缺乏引起，这些不仅会导致肾性骨营养不良，还会引起全身毒性，尤其是心血管疾病。
使用维生素D的活性形式骨化三醇进行治疗可降低血清甲状旁腺激素（PTH）水平，但可能导致高钙血症和高磷血症，增加CKD患者血管钙化的风险。新型维生素D受体激动剂（VDRAs）在治疗SHPT方面是否因其降低血液透析（HD）患者高钙血症和高磷血症的风险而更有用？
在本综述中，我们描述了新型VDRAs帕立骨化醇（1,25 - 二羟基 - 19 - 去甲维生素D2），它在血清钙和磷水平升高最小的情况下抑制PTH分泌。
结果/结论：在一些CKD动物模型中，帕立骨化醇不会引起血管钙化，而其他VDRAs会。这些数据可能解释了在HD患者观察性研究中看到的结果，其中与骨化三醇相比，帕立骨化醇与生存率提高相关。
