medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-4-190-198medsovet-6108Research ArticleНЕФРОЛОГИЯNEPHROLOGYМесто парикальцитола в терапии минеральных и костных нарушений при хронической болезни почекParicalcitol in management of chronic kidney disease–mineral and bone disorderhttps://orcid.org/0000-0001-6667-062XЕремкинаА. К.EremkinaA. K.

Еремкина Анна Константиновна, кандидат медицинских наук, заведующая отделением патологии околощитовидных желез

117036, Москва, ул. Дмитрия Ульянова, д. 11

SPIN-код: 8848-2660

Anna K. Eremkina, Cand. Sci. (Med.), Head of Parathyroid Gland Pathology Department

11, Dmitry Ulyanov St., Moscow, 117036

a.lipatenkova@gmail.comhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaM. G.

Мокрышева Наталья Георгиевна, чл.-корр. РАН, доктор медицинских наук, профессор, директор

117036, Москва, ул. Дмитрия Ульянова, д. 11

SPIN-код: 5624-3875

Natalya G. Mokrysheva, Corresponding Member RAS, Dr. Sci. (Med.), Professor, Director

11, Dmitry Ulyanov St., Moscow, 117036

parathyroid.enc@gmail.comНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation20212004202104190198Copyright © Еремкина А.К., Мокрышева Н.Г., 20212021Еремкина А.К., Мокрышева Н.Г.Eremkina A.K., Mokrysheva M.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6108

Минеральные и костные нарушения при хронической болезни почек (ХБП) – системная патология костно-минерального гомеостаза, проявляющаяся одним из  следующих признаков или их комбинацией: отклонениями в  показателях фосфорнокальциевого обмена – развитием вторичного гиперпаратиреоза; дефектами обмена кости, ее минерализации, объема, линейного роста или ее прочности; сосудистой или тканевой кальцификацией. Расстройства метаболизма витамина D в виде снижения уровня 1,25(OH)2D  (кальцитриола) и  повышение уровня интактного паратиреоидного гормона  (иПТГ) происходят на самых ранних этапах развития ХБП. Вторичный гиперпаратиреоз ассоциирован с высокой заболеваемостью и смертностью пациентов с ХБП 3–5Д-стадиями. Длительно декомпенсированное течение вторичного гиперпаратиреоза у пациентов с нарушением функции почек приводит к необратимым изменениям в различных системах организма, резистентности к консервативным методам терапии и необходимости хирургического вмешательства. В виду снижения ренальной продукции кальцитриола особую роль в  коррекции ВГПТ выполняют активаторы витамин-D-чувствительного рецептора. Они положительно влияют на снижение уровня иПТГ, костный обмен. Также представлены данные о плейотропных эффектах препаратов, имеющих решающее значение для профилактики фиброза почек и внескелетной кальцификации. В настоящем обзоре основное внимание уделено участию витамина D в патогенезе минеральных и костных нарушений и роли парикальцитола в их коррекции. Эффективность парикальцитола у пациентов с различными стадиями ХБП оценивалась в большом количестве наблюдательных и рандомизированных клинических исследований, результаты которых были суммированы в ряде метаанализов.

Mineral and bone disorders in chronic kidney disease (CKD) is a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism  (secondary hyperparathyroidism); abnormalities in  bone turnover, mineralization, volume, linear growth, or strength; or vascular or other soft tissue calcification. Decreasing 1,25(OH)2D (calcitriol) and rising parathyroid hormone (PTH) levels occur on early stages of CKD. Secondary hyperparathyroidism contributes to the high morbidity and mortality noted in this population. Long-term decompensation of  secondary hyperparathyroidism in  patients with impaired renal function leads to irreversible changes in multiple organ systems, resistance to conservative treatment and the requirement for surgical intervention. Suppress of renal CYP27B1 and the calcitriol deficiency play a major role in the development of mineral and bone disorders in CKD, thus VDR activators are widely used for management of secondary hyperparathyroidism. These medications are effective in suppression of PTH and demonstrate the positive effects on bone metabolism. There is evidence of pleiotropic effects of VDR activators that are crucial for the prevention of renal fibrosis and extraskeletal calcification. This review focuses on the involvement of vitamin D in the pathogenesis of mineral and bone disorders and the role of paricalcitol in their correction. The efficacy of paricalcitol in patients with various stages of CKD has been evaluated in a large number of observational and randomized clinical trials, the comparative effectiveness of paricalcitol therapy has been summarized in several metanalyses.

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