Vitamin D treatment of secondary hyperparathyroidism in patients with chronic kidney disease: the significance of vitamin D receptor activator selectivity
Abstract
Secondary hyperparathyroidism (SHPT) is one of the major complications of chronic kidney disease (CKD). It results from the combination of many events, starting with deficiency of 1,25 dihydroxycholecalciferol (activated vitamin D), decreased activation of the vitamin D receptor (VDR), hypocalcemia, hyperphosphatemia, increased PTH, parathyroid gland hyperplasia and PTH resistance, finally leading to completely developed mineral and bone disorder (CKDMBD). There are three classes of drugs used for SHPT treatment: 1. nonselective VDR activators or agonists (nonselective VDRAs), 2. selective VDRAs, and 3. calcimimetics. Recent evidence suggests that VDRAs are associated with potential beneficial effects beyond bone and mineral metabolism, such as antiinflammatory and antithrombotic effect, inhibition of vascular calcification and survival advantage. Actual objectives for treating CKD patients with selective VDRAs are to retain or amplify the effects of nonselective VDRAs on PTH supression with lesser effects on serum calcium and phosphorus levels. This article reviews the patophysiology of SHPT, the data on vitamin D for the treatment of SHPT in CKD patients, with emphasis on selective VDRAs.Downloads
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