CKD骨矿物质-血管综合征的防治课件.ppt

Vitamin D在抑制PTH的同时升高了钙,磷 ADVANCE研究—钙模拟剂对冠状动脉钙化的作用 ADVANCE研究—西那卡塞对各项主要参数的影响 ADVANCE研究：结论 Therapeutic Interventions for Managing Secondary HPT Active vitamin D sterols are widely used for managing secondary HPT in CKD patients. These drugs mimic the effects of endogenous calcitriol, and thereby supplement the low levels found in CKD. Active vitamin D sterols reduce pre-pro-PTH gene transcription and PTH synthesis, resulting in a decrease in serum PTH levels.1 However, active vitamin D sterols also stimulate intestinal calcium and phosphate absorption, which increases serum calcium and phosphate and raises the risk for hypercalcemia and hyperphosphatemia.2 Importantly, hypercalcemia, hyperphosphatemia, and elevated Ca x P have been implicated in vascular calcification, and in turn may contribute to cardiovascular mortality in CKD patients.3 These effects limit the safe dosing of vitamin D sterols. Treatment with active vitamin D sterols must balance the need to reduce PTH with the risks of hypercalcemia and hyperphosphatemia. References: 1. Silver J, Naveh-Many T, Mayer H, Schmelzer HJ, Popovtzer MM. Regulation by vitamin D metabolites of parathyroid hormone gene transcription in vivo in the rat. J Clin Invest. 1986;78:1296-1301. 2. Sprague SM, Llach F, Amdahl M, Taccetta C, Batlle D. Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int. 2003;63:1483-1490. 3. Goodman WG. Calcimimetics: a remedy for all problems of excess prarathyroid hormone activity in chronic kidney disease? Curr Opin Nephrol Hypertens. 2005;14:355-360. Therapeutic Interventions for Managing Secondary HPT Clinical studies show that the calcimimetic cinacalcet is effective in reducing serum PTH levels in dialysis patients with secondary HPT.1,2 The decline in serum PTH occurred rapidly and was maintained during long-term therapy. Cinacalcet reduced serum calcium and phosphorus while lowering PTH.1 The next few slides present results of therapy with vita