Brancaccio D, Cozzolino M
Cattedra di Nefrologia, Universita' degli Studi, Milano and Unita' di Nefrologia e Centro Dialisi Simone Martini, Milano - Italy.
G Ital Nefrol. 2009 Nov-Dec;26 Suppl 49:S18-22.
Cardiovascular complications are the most common cause of death in uremic patients, especially those on chronic dialysis. One of the major findings is massive calcium deposition in the vessel walls. There is general consensus about the correlation between the distribution of vascular calcification and increased risk of death due to cardiovascular disease. An emerging issue is the possible beneficial role of vitamin D receptor (VDR) activation in reducing the morbidity and mortality rates in patients on chronic dialysis, as shown in large, although retrospective, studies. Still open is the possible role of CaSR activators in ameliorating the clinical course of patients on dialysis, although calcimimetics are able to improve the Ca-P-PTH serum profile and increase the number of patients within the international guidelines parameters. This review has been structured to give the readers an updated opinion on the possible positive impact of VDR and CaSR activators in terms of all-cause and cardiovascular morbidity and mortality in dialysis patients.
心血管并发症是尿毒症患者,尤其是长期接受透析治疗患者最常见的死亡原因。主要发现之一是血管壁中大量钙沉积。血管钙化分布与心血管疾病死亡风险增加之间的相关性已得到广泛共识。一个新出现的问题是,大型回顾性研究表明,维生素D受体(VDR)激活在降低长期透析患者的发病率和死亡率方面可能具有有益作用。钙敏感受体(CaSR)激活剂在改善透析患者临床病程方面的潜在作用仍不明确,尽管拟钙剂能够改善钙-磷-甲状旁腺激素血清指标,并使更多患者符合国际指南参数。本综述旨在让读者了解VDR和CaSR激活剂对透析患者全因发病率和死亡率以及心血管发病率和死亡率可能产生的积极影响的最新观点。