Cheng Steven, Coyne Daniel
a Washington University, Division of Nephrology, School of Medicine, Renal Division, Box 8129660 S, Euclid Avenue, Saint Louis, MO 63110-1010, USA.
b Washington University, Division of Nephrology, School of Medicine, Renal Division, Box 8129660 S, Euclid Avenue, Saint Louis, MO 63110-1010, USA.
Expert Rev Endocrinol Metab. 2006 Mar;1(2):159-165. doi: 10.1586/17446651.1.2.159.
Secondary hyperparathyroidism is a common complication of both chronic kidney and end-stage renal disease. Vitamin D appears to play a central role in the pathogenesis of this condition and active vitamin D replacement is usually a necessary component of its treatment. The ability to administer active vitamin D is limited by increases in calcium and phosphorus, predisposing patients to vascular calcifications and cardiovascular disease. Paricalcitol is a new vitamin D analog designed to suppress parathyroid secretion with less effect on serum levels of calcium and phosphorus. The application of paricalcitol in chronic kidney disease may slow the clinical course of secondary hyperparathyroidism and allow more effective suppression of parathyroid hormone while minimizing the concommitant risks of hypercalcemia and hyperphosphatemia. This article reviews the pathogenesis of secondary hyperparathyroidism and the data supporting the role of oral and intravenous paricalcitol in the treatment of secondary hyperparathyroidism in both chronic kidney disease and end-stage renal disease patients.
继发性甲状旁腺功能亢进是慢性肾脏病和终末期肾病的常见并发症。维生素D似乎在这种疾病的发病机制中起核心作用，补充活性维生素D通常是其治疗的必要组成部分。给予活性维生素D的能力受到钙和磷升高的限制，这使患者易患血管钙化和心血管疾病。帕立骨化醇是一种新型维生素D类似物，旨在抑制甲状旁腺分泌，对血清钙和磷水平的影响较小。帕立骨化醇在慢性肾脏病中的应用可能会减缓继发性甲状旁腺功能亢进的临床进程，并能更有效地抑制甲状旁腺激素，同时将高钙血症和高磷血症的伴随风险降至最低。本文综述了继发性甲状旁腺功能亢进的发病机制以及支持口服和静脉注射帕立骨化醇在慢性肾脏病和终末期肾病患者继发性甲状旁腺功能亢进治疗中作用的数据。
