Stubbs Jason R, Wetmore James B
Division of Nephrology and Hypertension and The Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA.
Semin Dial. 2011 May-Jun;24(3):298-306. doi: 10.1111/j.1525-139X.2011.00935.x.
Because secondary hyperparathyroidism is associated with morbidity and mortality in patients with chronic kidney disease, suppression of parathyroid hormone (PTH) and minimization of associated derangements in mineral metabolism are cardinal therapeutic goals. There is an ongoing debate regarding the proper treatment strategy for PTH suppression in this population. While some practitioners believe that calcitriol analogues should be the primary therapy in this setting, others contend that calcimimetics offer unique treatment benefits. Recent advancements in the understanding of the pathophysiology of secondary hyperparathyroidism and the secondary effects of these agents may help clarify this debate. Here, we review the classical actions of calcitriol analogues and calcimimetics on mineral metabolism. We also examine the potential nonclassical effects of these therapies on the renin-angiotensin-aldosterone system, proteinuria, vascular calcification, fibroblast growth factor-23, inflammation, and overall survival.
由于继发性甲状旁腺功能亢进与慢性肾脏病患者的发病率和死亡率相关，抑制甲状旁腺激素（PTH）并尽量减少矿物质代谢相关紊乱是主要治疗目标。对于该人群中PTH抑制的适当治疗策略，目前存在争议。一些从业者认为，骨化三醇类似物应作为此情况下的主要治疗方法，而另一些人则认为拟钙剂具有独特的治疗益处。对继发性甲状旁腺功能亢进病理生理学及这些药物的继发效应的最新认识进展可能有助于阐明这一争论。在此，我们回顾骨化三醇类似物和拟钙剂对矿物质代谢的经典作用。我们还研究了这些疗法对肾素 - 血管紧张素 - 醛固酮系统、蛋白尿、血管钙化、成纤维细胞生长因子 - 23、炎症和总体生存率的潜在非经典效应。
