Cardiovascular disease in chronic kidney failure: is there a role for vitamin D analogs?
Vitamin D3 is modified by vitamin D3-25-hydroxylase in the liver, and 25-hydroxyvitamin D3-1alpha-hydroxylase in the kidney, to form the active metabolite, 1,25-dihydroxyvitamin D3. Chronic kidney disease (CKD) is characterized by reduced synthesis of 1,25-dibydroxyvitamin D3, inadequate renal phosphate clearance and calcium imbalance, secondary hyperparathyroidism (SHPT) and bone disease. CKD patients encounter a much higher risk of cardiovascular disease (CVD) than the general public. The cardiovascular risk factors for CKD patients include conventional factors such as age, gender, hypertension, diabetes, dyslipidemia and smoking, and non-conventional factors, such as anemia, uremia, reduced vascular compliance, inflammation and various hormonal factors. Several vitamin D analogs are currently available for the treatment of SHPT, and recent clinical data show that these analogs provide survival benefit for CKD patients in the order of paricalcitol > calcitriol > no vitamin D analog, independent of parathyroid hormone and calcium. Moreover, the survival benefit seems to be associated with cardiovascular causes. The observations made from these clinical studies raised intriguing questions about the involvement of the vitamin D receptor locus (VDR) in the cardiovascular system. This review discusses recent data regarding the role of vitamin D and its analogs in the CVD associated with CKD.
Wu-Wong
J Ruth
JR
Abbott Laboratories, R4CM Building AP52, 200 Abbott Park Road, Abbott Park, IL 60064, USA. ruth.r.wuwong@abbott.com
Nakane
Masaki
M
Traylor
Linda
L
Ruan
Xiaoan
X
Kroeger
Paul E
PE
Tian
Jin
J
D002117:Calcitriol / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004872:Ergocalciferols / Q000627:therapeutic use; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000737:chemistry* / Q000627:therapeutic use
D002317:Cardiovascular Agents; D004872:Ergocalciferols; D007166:Immunosuppressive Agents; D014807:Vitamin D; C084656:paricalcitol; D002117:Calcitriol