Vitamin D analogs in uremia: integrating medical and nutritional issues

A system of regulatory molecules interacts at the cellular level to control and coordinate the many metabolic pathways that constitute normal mineral metabolism. Alterations that occur in uremia profoundly disrupt this intricate system of regulation. A lack of control poses serious consequences for patients with chronic renal disease, and restoring some level of control represents a significant treatment goal. To achieve adequate treatment, it is necessary to correct aberrations in the metabolism of the major regulatory molecules, parathyroid hormone, vitamin D, calcium, and phosphorus. The use of vitamin D hormone replacement therapy is one important part of this strategy, and the availability of newer vitamin D compounds may prove to be especially beneficial. The effective use of these compounds, nevertheless, depends on the coordinated efforts of each member of the health care team to design and implement an integrated treatment protocol that recognizes all aspects of intervention.