title: Beneficial effects of selective vitamin D receptor activation by paricalcitol in chronic kidney disease.
abstract: In chronic kidney disease patients, active vitamin D level progressively declines in the course of the disease. This phenomenon is accompanied by elevation of parathyroid hormone, resulting in secondary hyperparathyroidism (SHPT), increased phosphorus levels, and hypocalcemia. All these disorders are associated with high rates of cardiovascular morbidity and mortality in these patients. Many vitamin D analogs have been approved for the treatment of SHPT in renal patients. Currently, new and more selective vitamin D receptor activators (VDRAs) have been introduced in this therapy with the aim of reducing SHPT without the hypercalcemia and hyperphosphatemia associated with the use of nonselective VDRAs. In addition, amelioration in hypertension, albuminuria, insulin resistance, and inflammation have been suggested as consequences of vitamin D receptor (VDR) activation. In this work, we summarize the beneficial effects attributed to paricalcitol, the only selective, new generation VDRA, currently available in Europe and the USA, with proven efficacy in the control of SHPT both in hemodialysis (HD) and pre-dialysis patients. Paricalcitol exerts less calcemic and phosphatemic effects than other VDRAs and prevents deleterious bone resorption. Moreover, paricalcitol-based therapy has been related to beneficial effects that could favor survival rates in chronic kidney disease patients. These benefits include anti-inflammatory and antithrombotic effects, the inhibition of vascular smooth muscle cell proliferation, the reninangiotensin system, vascular calcification, and regression of left ventricular hypertrophy, which could reduce the risk of cardiovascular mortality.
authors.forename: Javier
authors.initials: J
authors.lastname: Donate-Correa
authors.forename: Virginia
authors.initials: V
authors.lastname: Domínguez-Pimentel
authors.forename: Mercedes
authors.initials: M
authors.lastname: Muros-de-Fuentes
authors.forename: Carmen
authors.initials: C
authors.lastname: Mora-Fernández
authors.forename: Ernesto
authors.initials: E
authors.lastname: Martín-Núñez
authors.forename: Violeta
authors.initials: V
authors.lastname: Cazaña-Pérez
authors.affiliation: Nephrology Service, University Hospital Nuestra Senora de Candelaria, 38010. Santa Cruz de Tenerife, Spain. jnavgon@gobiernodecanarias.org.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Navarro-González
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D004872:Ergocalciferols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D006996:Hypocalcemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D018167:Receptors, Calcitriol / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood
chemical_list: D004872:Ergocalciferols; D010281:Parathyroid Hormone; D018167:Receptors, Calcitriol; D014807:Vitamin D; D010758:Phosphorus; C084656:paricalcitol