medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-4-60-65medsovet-2333Research ArticleОСЛОЖНЕНИЯ САХАРНОГО ДИАБЕТАCOMPLICATIONS OF DIABETESМинерально-костные нарушения у пациентов с хронической болезнью почек и сахарным диабетом: реальные возможности кардио- и нефропротекцииMineral-bone disorders in patients with chronic kidney disease and diabetes mellitus: the real possibilities of cardio and nephroprotection.МокрышеваН. Г.MokryshevaN. G.

Доктор медицинских наук, профессор

МаганеваИ. С.MaganevaI. S.

MD, Prof.

Национальный медицинский исследовательский центр эндокринологии Минздрава РоссииРоссияNational Medical Research Center of Endocrinology of the Ministry of Health of RussiaRussian Federation201831032018046065Copyright © Мокрышева Н.Г., Маганева И.С., 20182018Мокрышева Н.Г., Маганева И.С.Mokrysheva N.G., Maganeva I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2333

Вторичный гиперпаратиреоз (ВГПТ) – инвалидизирующее осложнение хронической болезни почек (ХБП), которое характеризуется значительным увеличением скорости обменных процессов в костной ткани, приводящим к нарушению ее структуры и повышению риска переломов, а также к патологии сердечно-сосудистой системы. Дефицит витамина D, являющийся главным патогенетическим звеном развития минерально-костных нарушений (МКН), способствует снижению секреции инсулина, инсулинорезистентности и дефекту β-клеток поджелудочной железы (ПЖ). Благодаря воздействию на углеводный и липидный обмен, ренин-ангиотензин-альдостероновую систему (РААС), а также участию в оксидативном стрессе препараты витамина D рассматриваются сегодня как неотъемлемая часть лечения кардиоренального синдрома, концепция которого основана на существовании взаимно влияющих различных патогенетических факторов, оказывающих неблагоприятное влияние в отношении сердца и почек. Метаанализ обсервационных исследований показал, что высокая концентрация витамина D в сыворотке крови ассоциирована с уменьшением кардиометаболических расстройств на 43% у пациентов с сахарным диабетом (СД), ХБП и ВГПТ по сравнению с низкими концентрациями. К перспективным препаратам для коррекции фосфорно-кальциевого обмена, улучшения почечной функции и снижения сердечно-сосудистых рисков у данной когорты больных относится парикальцитол.

Secondary hyperparathyroidism (SHPT) is a disabling complication of chronic kidney disease (CKD), which is characterized by a significant increase in the rate of metabolic processes in bone tissue, leading to a disruption in its structure and an increased risk of fractures, as well as cardiovascular pathology. Vitamin D deficiency, which is the main pathogenetic link in the development of mineral-bone disorders (MBD), contributes to a decrease in insulin secretion, insulin resistance, and pancreatic β-cell defect. Due to the effects on carbohydrate and lipid metabolism, renin-angiotensin-aldosterone system (RAAS), and also participation in oxidative stress, vitamin D is considered today as an integral part of the treatment of cardiorenal syndrome, the concept of which is based on the existence of mutually affecting various pathogenetic factors that adversely affect in relation to the heart and kidneys. A meta-analysis of observational studies has shown that a high concentration of vitamin D in the blood serum is associated with a 43% reduction in cardiometabolic disorders in patients with diabetes mellitus (DM), CKD and SHPT, compared to low concentrations. Perspective drugs for correction of phosphoric-calcium metabolism, improvement of renal function and reduction of cardiovascular risks in this cohort of patients include paricalcitol.

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The authors declare that there are no conflicts of interest present.