Friedl Claudia, Zitt Emanuel
Department of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, Graz.
Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria.
Int J Nephrol Renovasc Dis. 2017 May 11;10:109-122. doi: 10.2147/IJNRD.S97637. eCollection 2017.
Secondary hyperparathyroidism (sHPT) represents the adaptive and very often, finally, maladaptive response of the organism to control the disturbed homeostasis of calcium, phosphorus, and vitamin D metabolism caused by declining renal function in chronic kidney disease (CKD). sHPT leads to cardiovascular and extravascular calcifications and is directly linked to an increased risk of cardiovascular morbidity and mortality as well as excess all-cause mortality. Vitamin D plays an important role in the development of sHPT. CKD patients are characterized by a high prevalence of hypovitaminosis D. Supplementation with both vitamin D prohormones cholecalciferol and ergocalciferol enables the achievement and maintenance of a normal vitamin D status when given in adequate doses over an appropriate treatment period. In patients with earlier stages of CKD, sHPT is influenced by and can be successfully treated with vitamin D prohormone supplementation, whereas in patients with very late stages of CKD and those requiring dialysis, treatment with prohormones seems to be of limited efficacy. This review gives an overview of the pathogenesis of sHPT, summarizes vitamin D metabolism, and discusses the existing literature regarding the role of vitamin D prohormone in the treatment of sHPT in patients with CKD.
继发性甲状旁腺功能亢进（sHPT）是机体对慢性肾脏病（CKD）中肾功能下降所导致的钙、磷及维生素D代谢稳态紊乱进行控制时的适应性反应，且这种反应最终常常会转变为适应不良。sHPT会导致心血管和血管外钙化，直接增加心血管疾病的发病和死亡风险以及全因死亡率。维生素D在sHPT的发生发展中起重要作用。CKD患者维生素D缺乏症的患病率很高。在适当的治疗期间给予足够剂量的维生素D原激素胆钙化醇和麦角钙化醇进行补充，能够实现并维持正常的维生素D状态。在CKD早期患者中，sHPT受维生素D原激素补充的影响，且补充维生素D原激素能够成功治疗sHPT；而在CKD晚期患者及需要透析的患者中，维生素D原激素治疗的疗效似乎有限。本文综述了sHPT的发病机制，总结了维生素D代谢，并讨论了关于维生素D原激素在CKD患者sHPT治疗中作用的现有文献。
