Nephrology Departments at Second University, Napoli, Italia.
BMC Nephrol. 2012 Nov 20;13:150. doi: 10.1186/1471-2369-13-150.
Whether paricalcitol (PCT) reduces proteinuria in the presence of intensified inhibition of Renin-Angiotensin-System (RAS) is poorly studied. We evaluated the antiproteinuric effect of PCT in non-dialysis chronic kidney disease (CKD) patients with proteinuria greater than 0.5 g/24 h persisting despite anti-RAS therapy titrated to minimize proteinuria in the absence of adverse effects.
Forty-eight CKD patients were studied in the first six months of add-on oral PCT (1 mcg/day) and three months after drug withdrawal.
Males were 87.5%, age 63 ± 14 yrs, systolic/diastolic blood pressure (BP) 143 ± 22/78 ± 11 mmHg, eGFR 29.7 ± 14.5 mL/min/1.73 m(2), diabetes 40%, and cardiovascular disease 38%. At referral in the center (28 months prior to study baseline), proteinuria was 2.44 (95% CI 1.80-3.04) g/24 h with 6 patients not receiving any anti-RAS and 42 treated with a single agent, at low dosage in most cases. At study baseline, twenty patients were under 2-3 anti-RAS drugs while twenty-eight received 1 agent at full dose and proteinuria resulted to be reduced versus referral to 1.23 g/24 h (95%CI 1.00-1.51). Six months of add-on PCT significantly decreased proteinuria to 0.61 g/24 h (95%CI 0.40-0.93), with levels less than 0.5 g/24 h achieved in 37.5% patients, in the absence of changes of BP and GFR. Proteinuria recovered to basal value after drug withdrawal. The extent of antiproteinuric response to PCT was positively associated with diabetes, eGFR and daily Na excretion (R(2) = 0.459, P < 0.0001). PTH decreased from 201 (IQR 92-273) to 83 (IQR 50-189) pg/mL.
In CKD patients, add-on PCT induces a significant reduction of proteinuria that is evident despite intensified anti-RAS therapy and larger in the presence of diabetes, higher GFR and unrestricted salt intake.
在强化肾素-血管紧张素系统（RAS）抑制的情况下，帕立骨化醇（PCT）是否减少蛋白尿的作用尚不清楚。我们评估了添加口服 PCT（每天 1 mcg）对蛋白尿大于 0.5 g/24 h 的非透析慢性肾脏病（CKD）患者的抗蛋白尿作用，这些患者在没有不良反应的情况下，抗 RAS 治疗滴定以尽量减少蛋白尿。
48 例 CKD 患者在添加口服 PCT 的前 6 个月（每天 1 mcg）和停药后 3 个月进行了研究。
男性占 87.5%，年龄 63 ± 14 岁，收缩压/舒张压（BP）143 ± 22/78 ± 11 mmHg，eGFR 29.7 ± 14.5 mL/min/1.73 m(2)，糖尿病占 40%，心血管疾病占 38%。在中心就诊时（研究基线前 28 个月），蛋白尿为 2.44（95%CI 1.80-3.04）g/24 h，其中 6 例未接受任何抗 RAS 治疗，42 例接受单一药物治疗，大多数情况下剂量较低。在研究基线时，20 例患者接受 2-3 种抗 RAS 药物治疗，而 28 例患者接受 1 种药物的全剂量治疗，与就诊时相比，蛋白尿减少至 1.23 g/24 h（95%CI 1.00-1.51）。6 个月的添加 PCT 显著降低蛋白尿至 0.61 g/24 h（95%CI 0.40-0.93），37.5%的患者蛋白尿水平低于 0.5 g/24 h，BP 和 GFR 无变化。停药后蛋白尿恢复至基础值。PCT 抗蛋白尿反应的程度与糖尿病、eGFR 和每日 Na 排泄量呈正相关（R(2) = 0.459，P < 0.0001）。PTH 从 201（IQR 92-273）降至 83（IQR 50-189）pg/mL。
在 CKD 患者中，添加 PCT 可显著降低蛋白尿，即使在强化 RAS 抑制治疗的情况下也是如此，而且在存在糖尿病、更高的 GFR 和不受限制的盐摄入时，这种降低更为明显。
