Utilization of alfacalcidol and active vitamin D analogs in chronic kidney disease
Por:
Urena-Torres, PA, Cozzolino, M, Bover, J
Publicada:
1 jun 2018
Resumen:
Secondary hyperparathyroidism (SHPT) is one of the most frequent and deleterious complication of chronic kidney disease (CKD). SHPT is also one of the principal components of the now called CKD-mineral and bone disorders (MBD) syndrome. It is usually prevented and treated by vitamin D derivatives. However, the rationale for the prescription of vitamin D sterols in those patients is still a matter of hotly debates, mainly because of unsatisfactory results from numerous observational and not well-controlled studies. Scanty clinical data on head-to-head comparisons between the multiple vitamin D sterols are currently available. Moreover, there is crescent expectations on nutritional vitamin D, as well as vitamin D receptor activators (VDRA), regarding their putative pleiotropic effects even in CKD patients, and the promising effects of VDRA against proteinuria and myocardial hypertrophy in diabetic CKD cohorts. Nevertheless, additional randomized controlled trials (RCT) are needed to answer to many open questions and incertitude considering the effect of nutritional vitamin D and VDRA on hard end points including the risk of skeletal fractures and of mortality in CKD patients. RCT comparing VDRA to calcimimetics in the control of SHPT are also needed in dialysis patients. The present review will visit these open questions that nephrologists should ask before starting a treatment by nutritional vitamin D or VDRA. (C) 2017 Societe francophone de nephrologie, dialyse et transplantation. Published by ElsevierMasson SAS. All rights reserved.
Filiaciones:
Urena-Torres, PA:
Clin Landy, Serv Nephrol & Dialyse, Ramsay Gen Sante, 23 Rue Landy, F-93400 St Ouen, France
Univ Paris 05, Necker Hosp, Dept Renal Physiol, F-75015 Paris, France
Cozzolino, M:
Univ Milan, Dept Hlth Sci, San Paolo Hosp, Renal Div, Milan, Italy
Bover, J:
Fundacio Puigvert, Dept Nephrol, C Cartagena 340-350, Barcelona 08025, Spain
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