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Vascular calcification in chronic kidney failure: role of vitamin D receptor

J Ruth Wu-Wong1, Joel Melnick

  • 1Abbott Laboratories, 100 Abbott Park Rd, Abbott Park, IL 60064, USA. ruth.r.wuwong@abbott.com

Current Opinion in Investigational Drugs (London, England : 2000)
|April 6, 2007
PubMed

Insights

Vitamin D receptor activator (VDRA) therapy offers survival benefits for chronic kidney disease (CKD) patients, despite concerns about vascular calcification. Different VDRAs may differentially impact CKD-related cardiovascular risks.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Endocrinology

Background:

  • Chronic kidney disease (CKD) patients face higher cardiovascular disease and mortality risks, linked to atherosclerosis and vascular calcification.
  • Vascular calcification is a regulated process involving an imbalance of inducing and inhibitory factors, with specific factors remaining unidentified.
  • The vitamin D receptor (VDR) is a nuclear receptor, and its activators (VDRAs) like paricalcitol and calcitriol treat secondary hyperparathyroidism in CKD.

Purpose of the Study:

  • To investigate the role of VDRAs in vascular calcification within CKD patients.
  • To reconcile the observed survival benefits of VDRA therapy with potential pro-calcification effects.
  • To explore differential effects of VDRAs on endocrine versus paracrine/autocrine VDR pathways.

Main Methods:

  • Literature review of existing studies on VDRA therapy and vascular calcification in CKD.
  • Analysis of clinical observations regarding VDRA therapy and patient survival, independent of mineral levels.
  • Examination of potential mechanisms by which VDRAs might influence vascular health.

Main Results:

  • Clinical data indicate a survival benefit order for VDRA therapy: paricalcitol > calcitriol > no VDRA.
  • This survival benefit exists independently of serum parathyroid hormone, phosphorus, and calcium levels.
  • Current literature presents inconsistent findings on the impact of VDRAs on vascular calcification.

Conclusions:

  • VDRA therapy demonstrates a survival advantage in CKD patients.
  • The seemingly contradictory effects of VDRAs on survival and potential calcification warrant further investigation.
  • Differential effects of various VDRAs on VDR signaling pathways may explain observed clinical outcomes.

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