Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000145.xml
Dialyse aktuell 2022; 26(10): 448-452
DOI: 10.1055/a-1941-9118
DOI: 10.1055/a-1941-9118
Schwerpunkt
Nephrologie
Vitamin D und sekundärer Hyperparathyreoidismus (sHPT) bei CKD im Spiegel der Zeit
Suche nach Antworten auf zentrale Fragen der sHPT-Therapie
ZUSAMMENFASSUNG
Ein Vitamin-D-Mangel trägt bei Patienten mit chronischer Nierenerkrankung (CKD: Chronic Kidney Disease) entscheidend zur Entstehung eines sekundären Hyperparathyreoidismus (sHPT) bei. Der Ausgleich dieses Mangels bei CKD-Patienten mit sHPT durch eine regelmäßige Vitamin-D-Substitution hat sich in den letzten Jahrzehnten in Form einer Springprozession vollzogen: Jeder Schritt vor und zurück hat neue, wichtige Erkenntnisse zu den komplexen Zusammenhängen zwischen der medikamentösen Substitution von Vitamin D und den Effekten auf das Parathormon (PTH) und den Knochenstoffwechsel erbracht. Heute können die unerwünschten Nebenwirkungen der Vitamin-D-Therapie (Hyperkalzämie, Hyperphosphatämie) besser kontrolliert werden. Trotzdem steht der Nachweis des klinischen Nutzens immer noch aus, da in den klinischen Studien bisher keine „harten“ Endpunkte (kardiovaskuläre Ereignisse, Frakturen, Mortalität etc.) untersucht worden sind.
Publication History
Article published online:
12 December 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Geng S, Kuang Z, Peissig PL. et al Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int 2019; 30: 2019-2025 DOI: 10.1007/s00198-019-05033-3.
- 2 Khan S. Secondary hyperparathyroidism is associated with higher cost of care among chronic kidney disease patients with cardiovascular comorbidities. Nephron Clin Pract 2007; 105: c159-c164 DOI: 10.1159/000099006.
- 3 Maxwell DR, Benjamin DM, Donahay SL. et al Calcitriol in dialysis patients. Clin Pharmacol Ther 1978; 23: 515-519 DOI: 10.1002/cpt1978235515.
- 4 Memmos DE, Eastwood JB, Talner LB. et al Double-blind trial of oral 1,25-dihydroxy vitamin D3 versus placebo in asymptomatic hyperparathyroidism in patients receiving maintenance haemodialysis. Br Med J (Clin Res Ed) 1981; 282: 1919-1924 DOI: 10.1136/bmj.282.6280.1919.
- 5 Malluche HH, Faugere MC. Renal osteodystrophy. N Engl J Med 1989; 321: 317-319 DOI: 10.1056/NEJM198908033210509.
- 6 Goodman WG., Goldin J, Kuizon BD. et al Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000; 342: 1478-1483 DOI: 10.1056/NEJM200005183422003.
- 7 Lazarus JM, Lowrie EG, Hampers CL. et al Cardiovascular disease in uremic patients on hemodialysis. Kidney Int Suppl 1975; 02: 167-175
- 8 Llach F, Velasquez Forero F. Secondary hyperparathyroidism in chronic renal failure: pathogenic and clinical aspects. Am J Kidney Dis 2001; 38 (Suppl. 05) S20-S33 DOI: 10.1053/ajkd.2001.28113.
- 9 Raggi P, Boulay A, Chasan-Taber S. et al Cardiac calcification in adult hemodialysis patients. J Am Coll Cardiol 2002; 39: 695-701 DOI: 10.1016/S0735-1097(01)01781-8.
- 10 Morosetti M, Jankovic L, Cetani F. et al High doses of intravenous calcitriol in the treatment of severe secondary hyperparathyroidism. J Nephrol 2004; 17: 95-100
- 11 Brandenburg VM, Floege J. Adynamic bone disease-bone and beyond. NDT Plus 2008; 01: 135-147 DOI: 10.1093/ndtplus/sfn040.
- 12 Cozzolino M, Brandenburg V. Paricalcitol and outcome: a manual on how a vitamin D receptor activator (VDRA) can help us to get down the “U”. Clin Nephrol 2009; 71: 593-601 DOI: 10.5414/cnp71593.
- 13 Suki WN, Zabaneh R, Cangiano JL. et al Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients. Kidney Int 2007; 72: 1130-1137 DOI: 10.1038/sj.ki.5002466.
- 14 Moe SM, Drüeke T, Lameire N. et al Chronic kidney disease-mineral-bone disorder: a new paradigm. Adv Chronic Kidney Dis 2007; 14: 3-12 DOI: 10.1053/j.ackd.2006.10.005.
- 15 KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Kidney Int Suppl. 2009; 113: S1-S130 DOI: 10.1038/ki.2009.188.
- 16 Martin KJ, González EA, Gellens M. et al 19-Nor-1-alpha-25-dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 1998; 09: 1427-1432 DOI: 10.1681/ASN.V981427.
- 17 Llach F, Keshav G, Goldblat MV. et al Suppression of parathyroid hormone secretion in hemodialysis patients by a novel vitamin D analogue: 19-nor-1,25-dihydroxyvitamin D2. Am J Kidney Dis 1998; 32 (Suppl. 02) S48-S54 DOI: 10.1053/ajkd.1998.v32.pm9808143.
- 18 Teng M, Wolf M, Lowrie E. et al Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 2003; 349: 446-456 DOI: 10.1056/NEJMoa022536.
- 19 Wang AY-M, Fang F, Chan J. et al Effect of paricalcitol on left ventricular mass and function in CKD – the OPERA trial. J Am Soc Nephrol 2014; 25: 175-186 DOI: 10.1681/ASN.2013010103.
- 20 Thadhani R, Appelbaum E, Pritchett Y. et al Vitamin D therapy and cardiac structure and function in patients with chronic kidney disease: the PRIMO randomized controlled trial. J Am Med Assoc 2012; 307: 674-684 DOI: 10.1001/jama.2012.120.
- 21 Cozzolino M, Bernard L, Csomor PA. Active vitamin D increases the risk of hypercalcaemia in non-dialysis chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis. Clin Kidney J 2021; 14: 2437-2443 DOI: 10.1093/ckj/sfab091.
- 22 Bover J, Gunnarsson J, Csomor P. et al Impact of nutritional vitamin D supplementation on parathyroid hormone and 25-hydroxyvitamin D levels in non-dialysis chronic kidney disease: a meta-analysis. Clin Kidney J 2021; 14: 2177-2186 DOI: 10.1093/ckj/sfab035.
- 23 Petkovich M, Melnick J, White J. et al Modified-release oral calcifediol corrects vitamin D insufficiency with minimal CYP24A1 upregulation. J Steroid Biochem Mol Biol 2015; 148: 283-289 DOI: 10.1016/j.jsbmb.2014.11.022.
- 24 Sprague SM, Strugnell SA, Bishop CW. Extended-release calcifediol for secondary hyperparathyroidism in stage 3–4 chronic kidney disease. Expert Rev Endocrinol Metab 2017; 12: 289-301 DOI: 10.1080/17446651.2017.1347501.
- 25 Fadda G, Germain MJ, Broumand V. et al Real-world assessment: clinical effectiveness and safety of extended-release calcifediol. Am J Nephrol 2021; 52: 798-807 DOI: 10.1159/000518545.
- 26 Fernández-Martín JL, Martínez-Camblor P, Dionisi MP. et al Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrol Dial Transplant 2015; 30: 1542-1551 DOI: 10.1093/ndt/gfv099.
- 27 Agarwal R, Filippatos G, Pitt B. et al Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J 2022; 43: 474-484 DOI: 10.1093/eurheartj/ehab777.
- 28 Heerspink HJL, Stefánsson BV, Correa-Rotter R. et al Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020; 383: 1436-1446 DOI: 10.1056/NEJMoa2024816.