NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, 2650 North Ridge Avenue, Evanston, IL 60201, USA.
Clin J Am Soc Nephrol. 2010 Mar;5(3):512-8. doi: 10.2215/CJN.03850609. Epub 2010 Feb 4.
Effective treatment options for managing secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) have advanced steadily since the early 1980s, from surgical removal of the parathyroid gland to pharmacologic intervention focused on reestablishing hormonal and mineral balances. In addition, earlier recognition of CKD via estimated GFR and educational efforts have led to advancements in diagnosis and treatment of elevated parathyroid hormone (PTH) and vitamin D deficiency. Clinical studies support the efficacy and safety of vitamin D receptor (VDR) agonists as effective treatments for SHPT. A number of considerations to ensure optimal SHPT control in CKD patients are apparent. VDR agonists effectively treat SHPT and vitamin D deficiency, but dosing needs to be optimized for each patient because the patient responds in an individualized manner to treatment to suppress and stabilize PTH levels. VDR agonist therapy should be continuous to ensure continued PTH suppression, coupled with strict monitoring of calcium and phosphorus to ensure compliance within target ranges. Awareness of the complex and beneficial effects of VDR agonists contributes to improved benefits in bone mineral disease and lower mortality risks.
自 20 世纪 80 年代初以来，治疗慢性肾脏病（CKD）患者继发甲状旁腺功能亢进症（SHPT）的有效治疗方法不断发展，从甲状旁腺切除术到以重新建立激素和矿物质平衡为重点的药物干预。此外，通过估算肾小球滤过率（eGFR）更早地识别 CKD，并开展教育活动，促进了升高的甲状旁腺激素（PTH）和维生素 D 缺乏症的诊断和治疗。临床研究支持维生素 D 受体（VDR）激动剂作为治疗 SHPT 的有效方法的疗效和安全性。为了确保 CKD 患者的 SHPT 得到最佳控制，需要考虑许多因素。VDR 激动剂可有效治疗 SHPT 和维生素 D 缺乏症，但需要为每位患者优化剂量，因为患者对治疗的反应因人而异，以抑制和稳定 PTH 水平。VDR 激动剂治疗应持续进行，以确保持续抑制 PTH，并严格监测钙和磷，以确保在目标范围内的依从性。了解 VDR 激动剂的复杂而有益的作用有助于改善骨矿物质疾病的益处并降低死亡率风险。
