Verhave G, Siegert C E H
VU Medical Centre, Amsterdam, the Netherlands.
Neth J Med. 2010 Mar;68(3):113-8.
There is increasing evidence for health benefits accomplished by activated vitamin D through interaction with the vitamin D receptor (VDR) that go beyond calcium and bone homeostasis and regulation of parathyroid hormone (PTH) secretion. Treatment with vitamin D receptor agonists (VDRAs) is associated with reduced mortality in (pre)dialysis patients. Interestingly, these relations are independent of PTH levels and calcium x phosphorus product. This suggests the presence of biological functions of vitamin D that are independent of its interaction with the parathyroid glands. Because chronic kidney disease leads to increased cardiovascular mortality, mechanisms in which VDRAs can influence cardiovascular disease are discussed. These mechanisms comprise the potential ameliorating effects of VDRAs on atherosclerosis, arterial media calcification, cardiac hypertrophy, the renin-angiotensin system and thrombosis. Moreover, treatment strategies with VDRAs are discussed together with several recent observational studies. Treatment advice consists of correction of 25(OH) vitamin D deficiency, low-dose calcitriol in patients with secondary hyperparathyroidism, and activated vitamin D analogues may be indicated when higher doses are needed to suppress PTH secretion. New insights into biological and clinical effects of VDRAs may broaden the patient group that may benefit from VDRA treatment to patients with creatinine clearances in the 30 to 60 ml/min range.
越来越多的证据表明，活性维生素D通过与维生素D受体（VDR）相互作用带来的健康益处，超出了钙和骨稳态以及甲状旁腺激素（PTH）分泌调节的范畴。维生素D受体激动剂（VDRA）治疗与（预）透析患者死亡率降低相关。有趣的是，这些关系独立于PTH水平和钙×磷乘积。这表明维生素D存在独立于其与甲状旁腺相互作用的生物学功能。由于慢性肾脏病会导致心血管死亡率增加，因此讨论了VDRA影响心血管疾病的机制。这些机制包括VDRA对动脉粥样硬化、动脉中层钙化、心脏肥大、肾素 - 血管紧张素系统和血栓形成的潜在改善作用。此外，还讨论了VDRA的治疗策略以及近期的几项观察性研究。治疗建议包括纠正25（OH）维生素D缺乏，对继发性甲状旁腺功能亢进患者使用低剂量骨化三醇，当需要更高剂量来抑制PTH分泌时，可能需要使用活性维生素D类似物。对VDRA生物学和临床效应的新见解可能会将可能从VDRA治疗中受益的患者群体扩大到肌酐清除率在30至60 ml/min范围内的患者。
