Soares Abel Esteves, Maes Michael, Godeny Paula, Matsumoto Andressa Keiko, Barbosa Décio Sabbatini, da Silva Taysa Antonia F, Souza Flávio Henrique M O, Delfino Vinicius Daher Alvares
Nephrology Section, Department of Internal Medicine, State University of Londrina, Londrina, Brazil.
IMPACT Research Center, Deakin University, Geelong, Australia; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil.
Life Sci. 2017 Dec 15;191:175-179. doi: 10.1016/j.lfs.2017.10.028.
Vitamin D has anti-inflammatory, anti-fibrotic effect, and may block the intrarenal renin-angiotensin system. Adequate vitamin D levels in conjunction with the use of Angiotensin-converting Enzyme Inhibitors/Angiotensin Receptor Blockers may help to slow down chronic kidney disease progression.
To study a possible beneficial effect of vitamin D supplementation in chronic kidney disease patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on chronic kidney disease progression we performed a clinical study involving vitamin D supplementation in patients with deficiency of this vitamin. This study was conducted in two chronic kidney disease clinics in the city of Londrina, Brazil, from October 2010 to December 2012. It was involved stage 3 and 4 chronic kidney disease (estimated glomerular filtration rate between 60 and 15mL/min/1.73m) patients with and without vitamin D deficiency. The patients ingested six-month cholecalciferol 50,000IU oral supplementation to chronic kidney disease patients with vitamin D deficiency. We hypothesize changes in estimated glomerular filtration rate over study period.
Our data demonstrate reservation of estimated glomerular filtration with cholecalciferol supplementation to chronic kidney disease patients taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. The combination treatment of angiotensin converting enzyme inhibitors/angiotensin receptor blockers with cholecalciferol prevents the decline in estimated glomerular filtration in patients with chronic kidney disease following treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and may represent a valid approach to reduce renal disease progression in chronic kidney disease patients with vitamin D deficiency. This result needs confirmation in prospective controlled clinical trials.
维生素D具有抗炎、抗纤维化作用，可能会阻断肾内肾素 - 血管紧张素系统。充足的维生素D水平与使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂相结合，可能有助于减缓慢性肾脏病的进展。
为了研究在使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的慢性肾脏病患者中补充维生素D对慢性肾脏病进展可能产生的有益作用，我们开展了一项针对维生素D缺乏患者补充维生素D的临床研究。该研究于2010年10月至2012年12月在巴西隆德里纳市的两家慢性肾脏病诊所进行。研究对象为3期和4期慢性肾脏病（估计肾小球滤过率在60至15mL/min/1.73m之间）且伴有或不伴有维生素D缺乏的患者。对维生素D缺乏的慢性肾脏病患者口服补充六个月的50,000IU胆钙化醇。我们假设在研究期间估计肾小球滤过率会发生变化。
我们的数据表明，对服用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的慢性肾脏病患者补充胆钙化醇可保留估计肾小球滤过率。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂与胆钙化醇联合治疗可防止慢性肾脏病患者在接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂治疗后估计肾小球滤过率下降，这可能是减少维生素D缺乏的慢性肾脏病患者肾脏疾病进展的一种有效方法。这一结果需要在前瞻性对照临床试验中得到证实。
