慢性肾脏病与维生素D代谢

Chronic Kidney Disease and Vitamin D Metabolism

慢性肾脏病(CKD)患者以骨化三醇合成逐步减少为始动因素,导致甲状旁腺激素水平增加、矿物及骨骼代谢紊乱,肾脏和心血管损伤加速、异位钙化,病死率增加。补充骨化三醇、抑制甲状旁腺素(PTH)水平几十年来一直作为治疗CKD必要的治疗手段之一。但最新循证证据表明,骨化三醇改善肾脏预后和心脏保护作用与抑制PTH水平无关。此外,维生素D缺乏在肾脏疾病发生率显著增加,其加速肾脏疾病进展和增加病死率的风险高于骨化三醇缺乏。CKD患者存在维生素D和骨化三醇异常,影响了维生素D/骨化三醇的肾脏保护作用,形成病理生理恶性循环。

In chronic kidney disease（CKD）,the generation of calcitriol reduced gradually,leading to elevation of parathyroid hormone（PTH）,mineral and bone metabolism disorders,predisposing of renal and cardiovascular damage,ectopic calcification,and high mortality rate.Therefore,the safe correction of calcitriol deficiency to suppress PTH has been one of the necessary treatments.However,the new evidence-based evidence suggests that calcitriol replacement may improve outcomes through renal and cardio protective actions unrelated to PTH suppression.In addition,striking incidence of vitamin D deficiency occurs in kidney disease and associates more strongly than calcitriol deficiency with a higher risk for kidney disease progression and death.Abnormal vitamin D and calcitriol exist in patients with CKD,which impacts vitamin D/calcitriol renal protection,forming a vicious circle.