Uwaezuoke Samuel N
Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Front Clin Diabetes Healthc. 2021 Oct 15;2:763844. doi: 10.3389/fcdhc.2021.763844. eCollection 2021.
Previous studies have shown that vitamin D analogs (such as paricalcitol) can reduce albuminuria in patients with diabetes mellitus and retard the progression of diabetic kidney disease (DKD). A recent systematic review reported significant improvement of renal function in patients with DKD who received vitamin D or its analogs. Study-driven data about their use in improving DKD outcomes have continued to accumulate over the years.
This paper aims to systematically review the contemporary evidence about the effectiveness of vitamin D analogs in retarding the onset or progression of DKD.
With appropriate descriptors, two electronic databases (PubMed and Google Scholar) were searched for articles published between 2015 and 2021 in the English language. Primary studies that fulfilled the inclusion criteria were selected; their titles and abstracts were screened, and duplicates were removed. Relevant data were retrieved from the final selected studies using a preconceived data-extraction form.
A total of eight studies (three randomized-controlled trials, one prospective study, and four cross-sectional studies) were reviewed. A total of 6,243 participants were investigated in the eight studies and comprised young adults, middle-aged adults, and the elderly with a male-gender predominance. One randomized controlled trial reported that paricalcitol significantly improved renal function in type 1 diabetes patients with renal impairment when combined with renin-angiotensin-aldosterone system (RAAS) blockers. A strong correlation between vitamin D deficiency and DKD risk was noted in the majority of the cross-sectional studies. High doses of cholecalciferol (4,000 or 10,000 IU/day), given early in DKD, significantly reduced disease prevalence.
Paricalcitol may retard the onset or progression of DKD, especially if administered in combination with RAAS blockers. The association of vitamin D deficiency with DKD risk also supports this therapeutic effect. Future systematic reviews are still needed to strengthen the current evidence on therapeutic benefit of vitamin D or its analogs in DKD.
既往研究表明，维生素D类似物（如帕立骨化醇）可降低糖尿病患者的蛋白尿，并延缓糖尿病肾病（DKD）的进展。最近一项系统评价报告称，接受维生素D或其类似物治疗的DKD患者肾功能有显著改善。多年来，关于其用于改善DKD结局的研究驱动数据不断积累。
本文旨在系统评价关于维生素D类似物延缓DKD发病或进展有效性的当代证据。
使用适当的描述词，在两个电子数据库（PubMed和谷歌学术）中检索2015年至2021年期间发表的英文文章。选择符合纳入标准的原始研究；筛选其标题和摘要，并去除重复项。使用预先设计的数据提取表从最终选定的研究中检索相关数据。
共纳入八项研究（三项随机对照试验、一项前瞻性研究和四项横断面研究）。八项研究共纳入6243名参与者，包括年轻人、中年人和老年人，以男性为主。一项随机对照试验报告，帕立骨化醇与肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂联合使用时，可显著改善1型糖尿病肾功能不全患者的肾功能。大多数横断面研究发现维生素D缺乏与DKD风险之间存在强相关性。在DKD早期给予高剂量胆钙化醇（4000或10000 IU/天）可显著降低疾病患病率。
帕立骨化醇可能延缓DKD的发病或进展，尤其是与RAAS阻滞剂联合使用时。维生素D缺乏与DKD风险之间的关联也支持这种治疗效果。未来仍需要进行系统评价，以加强目前关于维生素D或其类似物对DKD治疗益处的证据。
