Department of Cardiology and Nephrology, Rhein-Maas-Klinikum Würselen, Mauerfeldchen 25, 52146 Würselen, Germany.
Departmentof General Internal Medicine and Nephrology, Robert-Bosch Hospital, Auerbachstraße 110, 70376 Stuttgart, Germany.
Nutrients. 2022 Jul 22;14(15):3009. doi: 10.3390/nu14153009.
The association between vitamin D deficiency and especially critical shortage of active vitamin D (1,25-dihydroxyvitamin D, calcitriol) with the development of secondary hyperparathyroidism (sHPT) is a well-known fact in patients with chronic kidney disease (CKD). The association between sHPT and important clinical outcomes, such as kidney disease progression, fractures, cardiovascular events, and mortality, has turned the prevention and the control of HPT into a core issue of patients with CKD and on dialysis. However, vitamin D therapy entails the risk of unwanted side effects, such as hypercalcemia and hyperphosphatemia. This review summarizes the developments of vitamin D therapies in CKD patients of the last decades, from calcitriol substitution to extended-release calcifediol. In view of the study situation for vitamin D insufficiency and sHPT in CKD patients, we conclude that the nephrology community has to solve three core issues: (1) What is the optimal parathyroid hormone (PTH) target level for CKD and dialysis patients? (2) What is the optimal vitamin D level to support optimal PTH titration? (3) How can sHPT treatment support reduction in the occurrence of hard renal and cardiovascular events in CKD and dialysis patients?
维生素 D 缺乏症，尤其是活性维生素 D（1,25-二羟维生素 D，骨化三醇）严重不足与继发性甲状旁腺功能亢进症（sHPT）的发展之间的关联，是慢性肾脏病（CKD）患者中众所周知的事实。sHPT 与重要的临床结局之间的关联，如肾脏病进展、骨折、心血管事件和死亡率，使得预防和控制 HPT 成为 CKD 患者和透析患者的核心问题。然而，维生素 D 治疗存在不良副作用的风险，如高钙血症和高磷血症。本综述总结了过去几十年中 CKD 患者维生素 D 治疗的发展，从骨化三醇替代物到延长释放的碳酸钙。鉴于 CKD 患者维生素 D 不足和 sHPT 的研究情况，我们得出结论，肾脏病学界必须解决三个核心问题：（1）CKD 和透析患者的最佳甲状旁腺激素（PTH）靶目标水平是多少？（2）支持最佳 PTH 滴定的最佳维生素 D 水平是多少？（3）sHPT 治疗如何有助于减少 CKD 和透析患者的硬肾和心血管事件的发生？
