Vitamin D receptor ligand therapy in chronic kidney disease.
Chronic kidney disease is a growing public health concern, and secondary hyperparathyroidism is one of the most serious associated comorbidities. In healthy individuals, precisely controlled feedback loops dynamically modulate parathyroid hormone (PTH) levels. As kidney function declines, phosphate retention, decreased 1a,25-dihydroxyvitamin D3, and a tendency to hypocalcemia leads to overstimulation of PTH production and parathyroid hyperplasia. Vitamin D receptor (VDR) ligands are essential tools for controlling parathyroid activity. This review highlights the current clinical and biochemical VDR ligand studies, focusing on the differences between selective and nonselective VDR ligands. It is apparent that VDR ligands have important roles in the management of secondary hyperparathyroidism. Selective VDR ligands, in particular, may offer additional benefits in the treatment of bone disease, and may potentially reduce adverse effects related to cardiovascular disease.
Gonzalez
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Division of Nephrology, Saint Louis University, St. Louis, MO 63110, USA. gonzalea@slu.edu
D050071:Bone Density Conservation Agents / Q000494:pharmacology*; D002117:Calcitriol / Q000378:metabolism* / Q000494:pharmacology; D004872:Ergocalciferols / Q000494:pharmacology; D015870:Gene Expression; D006801:Humans; D006887:Hydroxycholecalciferols / Q000494:pharmacology; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D010281:Parathyroid Hormone / Q000378:metabolism; D018167:Receptors, Calcitriol / Q000235:genetics / Q000378:metabolism*; D014808:Vitamin D Deficiency / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism
D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D018167:Receptors, Calcitriol; C042533:1 alpha-hydroxyergocalciferol; C084656:paricalcitol; D002117:Calcitriol; C008088:alfacalcidol