Galassi Andrea, Bellasi Antonio, Ciceri Paola, Pivari Francesca, Conte Ferruccio, Cozzolino Mario
a Department of Health Sciences, Renal Division , University of Milan , Milan , Italy.
b Renal & Dialysis Unit ASST Lariana , S. Anna Hospital , Como , Italy.
Expert Rev Clin Pharmacol. 2017 Oct;10(10):1073-1084. doi: 10.1080/17512433.2017.1371011. Epub 2017 Sep 4.
Deranged vitamin D metabolism represents an active trigger of secondary hyperparathyroidism (SHPT) in CKD. Correction of 25(OH)D deficiency by nutritional Vitamin D administration is suggested by KDIGO guidelines, to prevent and treat SHPT in CKD stage G3-G5 and G1T-G5T patients, although with a still inconsistent background. Nutritional vitamin D is available as cholecalciferol, ergocalciferol, or calcifediol. Superiority of calcifediol in increasing 25(OH)D levels has been suggested due to its better bioavailability. The safer pharmacokinetic of the recent modified-release (MR) formulation of calcifediol was effective in replenishing 25(OH)D levels with minimal impact on vitamin D catabolism and fibroblast-growth factor-23 (FGF-23) activation. Areas covered: the review discusses utility of calcifediol for treating SHPT in different CKD stages under physiology driven approach, focusing on vitamin D metabolism, guidelines suggestions and comparison between clinical effects on SHPT elicited by calcifediol, cholecalciferol and ergocalciferol. Expert commentary: although optimal targets of 25(OH)D and parathormone remain uncertain, calcifediol, especially in its newer MR formulation, may represent an intriguing option to combine an efficacious correction of 25(OH)D deficit and SHPT, with a limited impact on vitamin D catabolism and FGF-23 activation. Newer data are required to better explore the role of MR calcifediol in treating SHPT.
维生素D代谢紊乱是慢性肾脏病（CKD）继发性甲状旁腺功能亢进（SHPT）的一个活跃触发因素。KDIGO指南建议通过补充营养性维生素D来纠正25(OH)D缺乏，以预防和治疗G3 - G5期以及G1T - G5T期CKD患者的SHPT，尽管目前相关背景仍不一致。营养性维生素D有胆钙化醇、麦角钙化醇或骨化二醇等形式。由于骨化二醇具有更好的生物利用度，因此有人认为它在提高25(OH)D水平方面更具优势。近期改良释放（MR）剂型的骨化二醇具有更安全的药代动力学特性，能有效补充25(OH)D水平，同时对维生素D分解代谢和成纤维细胞生长因子23（FGF - 23）激活的影响最小。涵盖领域：本综述讨论了在生理驱动方法下，骨化二醇在治疗不同CKD阶段SHPT中的效用，重点关注维生素D代谢、指南建议以及骨化二醇、胆钙化醇和麦角钙化醇对SHPT临床疗效的比较。专家评论：尽管25(OH)D和甲状旁腺激素的最佳目标仍不确定，但骨化二醇，尤其是其更新的MR剂型，可能是一个有吸引力的选择，既能有效纠正25(OH)D缺乏和SHPT，又对维生素D分解代谢和FGF - 23激活影响有限。需要更新的数据来更好地探索MR骨化二醇在治疗SHPT中的作用。
