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Paricalcitol in management of chronic kidney disease–mineral and bone disorder
Author(s) -
Anna Eremkina,
M. G. Mokrysheva
Publication year - 2021
Publication title -
medicinskij sovet
Language(s) - English
Resource type - Journals
eISSN - 2658-5790
pISSN - 2079-701X
DOI - 10.21518/2079-701x-2021-4-190-198
Subject(s) - paricalcitol , secondary hyperparathyroidism , medicine , calcitriol , bone remodeling , endocrinology , hyperparathyroidism , kidney disease , parathyroid hormone , vitamin d and neurology , sevelamer , calcitriol receptor , hyperphosphatemia , chronic kidney disease mineral and bone disorder , bone mineral , renal osteodystrophy , osteoporosis , calcium
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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