New Acquisitions in Therapy of Secondary Hyperparathyroidism in Chronic Kidney Disease and Peritoneal Dialysis Patients: Role of Vitamin D Receptor Activators

Background: Many studies were carried out to investigate the relationship between single nucleotide polymorphisms (SNPs) in vitamin D receptor (VDR) gene with obesity. However, little is known about the role of VDR gene polymorphism with obesity in hemodialysis (HD) patients. Therefore, we aimed to investigate VDR gene TaqI, ApaI and FokI SNPs in overweight/obese HD patients. Methods: Seventy one normal weight and 68 overweight/obese HD patients were included in study. PCR-RFLP method was used for genotyping. Demographic and laboratory data obtained from medical records of patients. Results: For all three SNPs, no significant association was found between normal and overweight/obese patients (P>0.05). Lower HDL concentrations and higher levels of triglyceride (TG) and glucose were detected in the obese/overweight patients compared to normal weight (p<0.001 for HDL, and TG and p=0.023 for glucose). In obese/overweight patients, subjects with CC genotype of TaqI showed higher PTH level (717.1±616.4 pg/ml) than those TC genotype (342.7±360.8 pg/ml) and TT genotype (310.2±323.4 pg/ml) (p=0.028); higher TG level was found in patients with CC genotype of ApaI (627.3±653.0 mg/dl) compared to AA (223.3±156.6) and AC genotypes (193.1±85.4) (p<0.001). Obese/overweight patients carrying FokI TT genotype had higher glucose concentration compared to those carrying CC and CT genotypes (CC=183.4±128.4 mg/dl; TT=151.9±66.1 mg/dl; CT=107.6±41.9 mg/dl, p=0.008). Conclusions: Our study suggest that VDR TaqI, ApaI and FokI polymorphisms are not associated with obesity in HD patients. However, they might be increase the risk of secondary hyperparathyroidism, dyslipidemia, and hyperglycemia, which are among the most common obesity related comorbidities of chronic kidney disease.

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Evaluation of the role of vitamin D in chronic kidney disease, dialysis patients and its Impact on cardio vascular mortality

Benha Medical Journal ◽

10.21608/bmfj.2021.71835.1407 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Mohamed E. Ibrahim ◽

Kamal Okasha ◽

Ashraf Mahmoud ◽

Amany Gamal ◽

Ahmed Mansour

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Kidney Disease ◽

Dialysis Patients ◽

Cardio Vascular ◽

Vascular Mortality

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Control of Secondary Hyperparathyroidism by Vitamin D Receptor Agonists in Chronic Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03850609 ◽

2010 ◽

Vol 5 (3) ◽

pp. 512-518 ◽

Cited By ~ 23

Author(s):

Stuart M. Sprague ◽

Daniel Coyne

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Kidney Disease ◽

Secondary Hyperparathyroidism ◽

Vitamin D Receptor ◽

Receptor Agonists

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Vitamin D Metabolism and Its Role in Mineral and Bone Disorders in Chronic Kidney Disease in Humans, Dogs and Cats

Metabolites ◽

10.3390/metabo10120499 ◽

2020 ◽

Vol 10 (12) ◽

pp. 499

Author(s):

Fernanda C. Chacar ◽

Márcia M. Kogika ◽

Rafael V. A. Zafalon ◽

Marcio A. Brunetto

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Kidney Disease ◽

Secondary Hyperparathyroidism ◽

Vitamin D Deficiency ◽

Comparative Studies ◽

Mineral Metabolism ◽

Vitamin D Metabolism ◽

Bone Disorders

Some differences regarding Vitamin D metabolism are described in dogs and cats in comparison with humans, which may be explained by an evolutionary drive among these species. Similarly, vitamin D is one of the most important regulators of mineral metabolism in dogs and cats, as well as in humans. Mineral metabolism is intrinsically related to bone metabolism, thus disturbances in vitamin D have been implicated in the development of chronic kidney disease mineral and bone disorders (CKD-MBD) in people, in addition to dogs and cats. Vitamin D deficiency may be associated with Renal Secondary Hyperparathyroidism (RSHPT), which is the most common mineral disorder in later stages of CKD in dogs and cats. Herein, we review the peculiarities of vitamin D metabolism in these species in comparison with humans, and the role of vitamin D disturbances in the development of CKD-MBD among dogs, cats, and people. Comparative studies may offer some evidence to help further research about vitamin D metabolism and bone disorders in CKD.

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Secondary hyperparathyroidism in patient with type 2 diabetes and stages 3–4 chronic kidney disease

Diabetes Mellitus ◽

10.14341/dm9458 ◽

2018 ◽

Vol 21 (2) ◽

pp. 128-134

Author(s):

Lilit V. Egshatyan ◽

Natalya G. Mokrisheva

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Vitamin D ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Secondary Hyperparathyroidism ◽

Vitamin D Receptor ◽

Receptor Activation ◽

Mineral Density

Secondary hyperparathyroidism is an early complication of chronic kidney disease, with increasing severity as the glomerular filtration rate decreases and characterized by a progressive increase in parathyroid hormone and growth of the parathyroid glands. It is generally accepted that a deficiency in active form of vitamin D or calcitriol levels seems to play a relevant role in its development and progression of secondary hyperparathyroidism. A reduction in plasma calcitriol levels occurs early in renal disease. Major renal guidelines recommend use of vitamin D for secondary hyperparathyroidism in chronic kidney disease. In the treatment vitamin D receptor activation inhibit glandular hyperplasia; reduce parathyroid hormone levels impact on bone turnover and mineral density. Treatment with calcitriol can occasionally result in hypercalcemia and hyperphosphatemia in renal patients due promotes intestinal calcium and phosphorus absorption. This limits its suitability for the treatment. But next generation vitamin-D analogs such as paricalcitol have lower intestinal absorption of calcium, phosphorous and significantly lowers renin levels, albuminuria and blood pressure. In this article, we present the case of a Caucasian male with type 2 diabetes and secondary hyperparathyroidism in stages 34 chronic kidney disease. Our case study shows that in treating for secondary hyperparathyroidisms selective vitamin D receptor activation with paricalcitol reduction of levels parathyroid hormone, albuminuria, offering low chance hypercalcemia, hyperphosphatemia and other side effects.

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Intraperitoneal Calcitriol for Treatment of Severe Hyperparathyroidism in Children with Chronic Kidney Disease: A Therapy Forgotten

Peritoneal Dialysis International ◽

10.3747/pdi.2015.00215 ◽

2016 ◽

Vol 36 (6) ◽

pp. 688-690 ◽

Cited By ~ 2

Author(s):

Rahul Chanchlani ◽

Susan Ackerman ◽

Elizabeth Piva ◽

Elizabeth Harvey

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Secondary Hyperparathyroidism ◽

Active Vitamin ◽

Active Vitamin D ◽

Oral Formulations ◽

Active Vitamin D Sterols ◽

Intravenous Formulation

Active Vitamin D sterols such as calcitriol and alfacalcidol are quite effective in the treatment of mineral bone disease secondary to chronic kidney disease. However, some children on peritoneal dialysis (PD) are resistant to oral formulations of active Vitamin D, and use of an intravenous formulation in such patients is inconvenient. In these children, intraperitoneal (IP) calcitriol has been shown to be effective in the treatment of secondary hyperparathyroidism. However, its use has declined. We report 2 children, aged 1 and 9.5 years, on chronic cycler PD with severe secondary hyperparathyroidism refractory to oral active Vitamin D who were successfully treated with IP calcitriol for a period of 12 and 4 months, respectively. We also discuss the published literature on the efficacy of IP calcitriol for treatment of secondary hyperparathyroidism and specific considerations for its use in PD patients.

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