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Beneficial effects of selective vitamin D receptor activation by paricalcitol in chronic kidney disease
Javier Donate-Correa, Virginia Domínguez-Pimentel, Mercedes Muros-de-Fuentes
1Nephrology Service, University Hospital Nuestra Senora de Candelaria, 38010. Santa Cruz de Tenerife, Spain. jnavgon@gobiernodecanarias.org.
Insights
Selective vitamin D receptor activators like paricalcitol effectively manage secondary hyperparathyroidism in chronic kidney disease patients. This treatment offers cardiovascular benefits and reduces mortality risk without significant hypercalcemia or hyperphosphatemia.
Area of Science:
- Nephrology
- Endocrinology
- Cardiology
Background:
- Chronic kidney disease (CKD) is linked to declining active vitamin D levels, leading to secondary hyperparathyroidism (SHPT).
- SHPT, characterized by elevated parathyroid hormone, phosphorus, and hypocalcemia, significantly increases cardiovascular morbidity and mortality in CKD patients.
- Existing vitamin D analogs for SHPT treatment can cause hypercalcemia and hyperphosphatemia.
Purpose of the Study:
- To review the benefits of paricalcitol, a selective vitamin D receptor activator (VDRA), for treating SHPT in CKD patients.
- To highlight paricalcitol's efficacy in controlling SHPT with reduced calcemic and phosphatemic effects compared to nonselective VDRAs.
- To explore paricalcitol's potential positive impacts on cardiovascular health and survival in CKD.
Main Methods:
- Review of existing literature on paricalcitol's use in CKD patients.
- Analysis of paricalcitol's effects on SHPT markers (parathyroid hormone, calcium, phosphorus).
- Evaluation of paricalcitol's impact on cardiovascular risk factors and outcomes.
Main Results:
- Paricalcitol demonstrates efficacy in managing SHPT in both hemodialysis and pre-dialysis CKD patients.
- Paricalcitol exhibits a lower propensity for causing hypercalcemia and hyperphosphatemia compared to other VDRAs.
- Paricalcitol is associated with reduced bone resorption and potential cardiovascular benefits, including anti-inflammatory and anti-thrombotic effects.
Conclusions:
- Paricalcitol is an effective and selective VDRA for SHPT treatment in CKD patients.
- Paricalcitol offers a favorable safety profile regarding calcium and phosphorus levels.
- Paricalcitol-based therapy may improve survival rates in CKD patients by mitigating cardiovascular risks.
Abstract:
In chronic kidney disease patients, active vitamin D level progressively declines in the course of the disease. This phenomenon is accompanied by elevation of parathyroid hormone, resulting in secondary hyperparathyroidism (SHPT), increased phosphorus levels, and hypocalcemia. All these disorders are associated with high rates of cardiovascular morbidity and mortality in these patients. Many vitamin D analogs have been approved for the treatment of SHPT in renal patients. Currently, new and more selective vitamin D receptor activators (VDRAs) have been introduced in this therapy with the aim of reducing SHPT without the hypercalcemia and hyperphosphatemia associated with the use of nonselective VDRAs. In addition, amelioration in hypertension, albuminuria, insulin resistance, and inflammation have been suggested as consequences of vitamin D receptor (VDR) activation. In this work, we summarize the beneficial effects attributed to paricalcitol, the only selective, new generation VDRA, currently available in Europe and the USA, with proven efficacy in the control of SHPT both in hemodialysis (HD) and pre-dialysis patients. Paricalcitol exerts less calcemic and phosphatemic effects than other VDRAs and prevents deleterious bone resorption. Moreover, paricalcitol-based therapy has been related to beneficial effects that could favor survival rates in chronic kidney disease patients. These benefits include anti-inflammatory and antithrombotic effects, the inhibition of vascular smooth muscle cell proliferation, the reninangiotensin system, vascular calcification, and regression of left ventricular hypertrophy, which could reduce the risk of cardiovascular mortality.
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