Active vitamin D analogs, maxacalcitol and alfacalcidol, as maintenance therapy for mild secondary hyperparathyroidism in hemodialysis patients – a randomized study

2014 ◽  
Vol 52 (05) ◽  
pp. 360-368
Author(s):  
Hirokazu Honda ◽  
Fumihiko Koiwa ◽  
Hiroaki Ogata ◽  
Kanji Shishido ◽  
Takashi Sekiguchi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Maintenance Therapy ◽  
Secondary Hyperparathyroidism ◽  
Randomized Study ◽  
Hemodialysis Patients ◽  
Active Vitamin ◽  
Vitamin D Analogs ◽  
Active Vitamin D

scholarly journals Mortality in Hemodialysis Patients with COVID-19, the Effect of Paricalcitol or Calcimimetics

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2559
Author(s):  
María Dolores Arenas Jimenez ◽  
Emilio González-Parra ◽  
Marta Riera ◽  
Abraham Rincón Bello ◽  
Ana López-Herradón ◽  
...  
Keyword(s):  
Vitamin D ◽  
Mortality Rate ◽  
Secondary Hyperparathyroidism ◽  
Cox Regression ◽  
Serum Vitamin ◽  
Hemodialysis Patients ◽  
Active Vitamin ◽  
Cox Regression Analysis ◽  
Active Vitamin D ◽  
The Impact

Background. In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. In regular hemodialysis (HD) patients, there is VD deficiency and markedly reduced calcitriol levels, which may predispose them to worse outcomes of COVID-19 infection. Some hemodialysis patients receive treatment with drugs for secondary hyperparathyroidism, which have well known pleiotropic effects beyond mineral metabolism. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. Methods. A cross-sectional retrospective observational study was conducted from 12 March to 21 May 2020 in 288 HD patients with positive PCR for SARS-CoV2. Patients were from 52 different centers in Spain. Results. The percent of HD patients with COVID-19 was 6.1% (288 out of 4743). Mortality rate was 28.4% (81/285). Three patients were lost to follow-up. Serum 25(OH)D (calcidiol) level was 17.1 [10.6–27.5] ng/mL and was not significantly associated to mortality (OR 0.99 (0.97–1.01), p = 0.4). Patients receiving active vitamin D medications (16/94 (17%) vs. 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs. 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs. 62/168 (36.9%); p < 0.001), and also those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs. 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug. Multivariate Cox regression analysis confirmed this increased survival. Conclusions. Our findings suggest that the use of paricalcitol, calcimimetics or the combination of both, seem to be associated with the improvement of survival in HD patients with COVID-19. No correlation was found between serum VD levels and prognosis or outcomes in HD patients with COVID-19. Prospective studies and clinical trials are needed to support these findings.

Design and synthesis of active vitamin D analogs

2010 ◽  
Vol 121 (1-2) ◽  
pp. 7-12 ◽  
Author(s):  
Silvina Eduardo-Canosa ◽  
Ramón Fraga ◽  
Rita Sigüeiro ◽  
Maria Marco ◽  
Natacha Rochel ◽  
...  
Keyword(s):  
Vitamin D ◽  
Active Vitamin ◽  
Vitamin D Analogs ◽  
Design And Synthesis ◽  
Active Vitamin D

Calcimimetic R-568 or calcitriol: equally beneficial on progression of renal damage in subtotally nephrectomized rats

2008 ◽  
Vol 294 (4) ◽  
pp. F748-F757 ◽  
Author(s):  
Grzegorz Piecha ◽  
Gabor Kokeny ◽  
Kumiko Nakagawa ◽  
Nadezda Koleganova ◽  
Aman Geldyyev ◽  
...  
Keyword(s):  
Vitamin D ◽  
Secondary Hyperparathyroidism ◽  
Kidney Damage ◽  
Receptor Protein ◽  
Membrane Thickness ◽  
Sprague Dawley ◽  
Active Vitamin ◽  
Basement Membrane Thickness ◽  
Active Vitamin D ◽  
Mean Width

Patients with renal insufficiency develop secondary hyperparathyroidism. Monotherapy with active vitamin D or calcimimetics ameliorates secondary hyperparathyroidism. We compared kidney damage in subtotally nephrectomized (SNX) rats treated with active vitamin D (calcitriol) or the calcimimetic R-568. Male Sprague-Dawley SNX and sham-operated (sham-op) rats were randomized into the following treatment groups: SNX + R-568, SNX + calcitriol, SNX + vehicle, sham-op + R-568, sham-op + calcitriol, and sham-op + vehicle. Albuminuria and blood pressure were monitored and kidneys were examined using morphometry, immunohistochemistry, quantitative RT-PCR, and in situ hybridization. Parathyroid hormone concentrations were lowered to the same extent by the two interventions, although phosphorus and the calcium-phosphorus product were reduced only by R-568 treatment. SNX rats developed marked albuminuria, which was significantly reduced in ad libitum- and pair-fed animals treated with R-568 and animals treated with calcitriol. Mean glomerular volume (6.05 ± 1.46 vs. 2.70 ± 0.91 mm3), podocyte volume (831 ± 127 vs. 397 ± 67 μm3), the degree of foot process fusion (mean width of foot processes = 958 ± 364 vs. 272 ± 35 nm), and glomerular basement membrane thickness (244 ± 6 vs. 267 ± 23 nm), as well as desmin staining, were significantly higher in vehicle-treated SNX than sham-operated animals. These changes were ameliorated with R-568 and calcitriol. In SNX, as well as sham-operated, animals, expression of the calcium-sensing receptor (protein and mRNA) was upregulated by treatment with the calcimimetic, but not calcitriol. Calcitriol and R-568 were similarly effective in ameliorating kidney damage.

The Effect of Active Vitamin D Administration on Muscle Mass in Hemodialysis Patients

2013 ◽  
Vol 33 (11) ◽  
pp. 837-846 ◽  
Author(s):  
Atsushi Mori ◽  
Tomoya Nishino ◽  
Yoko Obata ◽  
Masayuki Nakazawa ◽  
Misaki Hirose ◽  
...  
Keyword(s):  
Vitamin D ◽  
Muscle Mass ◽  
Hemodialysis Patients ◽  
Active Vitamin ◽  
Active Vitamin D

scholarly journals Long-term control of secondary hyperparathyroidism by combination therapy with cinacalcet hydrochloride and intravenous active vitamin D

2012 ◽  
Vol 45 (5) ◽  
pp. 393-399
Author(s):  
Kazumichi Ohta ◽  
Hiroyuki Yamamoto ◽  
Kazunobu Kattou ◽  
Mika Ikebe ◽  
Norisato Ikebe ◽  
...  
Keyword(s):  
Vitamin D ◽  
Combination Therapy ◽  
Secondary Hyperparathyroidism ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Cinacalcet Hydrochloride

MO058INHIBITION OF OSTEOCLAST DIFFERENTIATION BY 1.25-D AND THE CALCIMIMETIC KP2326 REVEALS 1.25-D RESISTANCE IN ADVANCED CKD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Julie Bernardor ◽  
Sacha Flammier ◽  
Bruno Ranchin ◽  
Segolene Gaillard ◽  
Diane Platel ◽  
...  
Keyword(s):  
Vitamin D ◽  
Bone Resorption ◽  
Bone Cells ◽  
Osteoclast Differentiation ◽  
Inhibitory Effect ◽  
Active Vitamin ◽  
Vitamin D Analogs ◽  
Active Vitamin D ◽  
Ckd Stage ◽  
Osteoclastic Differentiation

Abstract Background and Aims Active vitamin D analogs and calcimimetics are cornerstones for managing secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD). Their direct effects on bone cells remain to be determined. Method Peripheral blood mononuclear cells (PBMCs) of 19 pediatric CKD patients and 6 healthy donors (HD) were differentiated into osteoclasts in presence of M-CSF and RANKL. Effect of combined or single treatment with active vitamin D (1.25-D) and/or the calcimimetic KP2326 were evaluated onto osteoclast differentiation and osteoclast mediated bone resorption. Results 1.25-D inhibited osteoclastic differentiation, a significant resistance to 1.25-D was observed when CKD worsens. A significant albeit less important inhibitory effect of KP2326 on osteoclastic differentiation was also found both in cells derived from HD and CKD patients, through an activation of the Erk pathway. This inhibitory effect was not modified by CKD stage. Combinatorial treatment with 1.25-D and KP2326 did not result in synergistic effects. Last, KP2326 significantly inhibited human osteoclast-mediated bone resorption. Conclusion Both 1.25-D and KP2326 inhibit osteoclastic differentiation, however to a different extent. Whilst 1.25-D has no significant effect on bone resorption, KP2326 inhibits bone resorption. Recent data showed that calcimimetics also have a direct anabolic effect on bone, through the stimulation of osteoblastic differentiation and mineralization in human mesenchymal stem cells in vitro. All these results provide a strong rationale for a global positive effect of calcimimetics on bone remodeling. Calcimimetics also significantly decrease FGF23 levels. In the setting of global systematic deleterious effects of high FGF23 levels in CKD, and keeping in mind that active vitamin D analogs stimulate FGF 23 production, all these data could favor the use of decreased doses of 1.25-D with low-doses of calcimimetics in SHPT in dialysis, the combination of these two therapies already being proposed in the 2017 K-DIGO guidelines.

scholarly journals The risk of medically uncontrolled secondary hyperparathyroidism depends on parathyroid hormone levels at haemodialysis initiation

2020 ◽  
Vol 36 (1) ◽  
pp. 160-169
Author(s):  
Nahid Tabibzadeh ◽  
Angelo Karaboyas ◽  
Bruce M Robinson ◽  
Philipp A Csomor ◽  
David M Spiegel ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Secondary Hyperparathyroidism ◽  
Patient Characteristics ◽  
Risk Difference ◽  
First Year ◽  
Active Vitamin ◽  
Adjusted Risk ◽  
Active Vitamin D ◽  
Dialysis Outcomes

Abstract Background Optimal parathyroid hormone (PTH) control during non-dialysis chronic kidney disease (ND-CKD) might decrease the subsequent risk of parathyroid hyperplasia and uncontrolled secondary hyperparathyroidism (SHPT) on dialysis. However, the evidence for recommending PTH targets and therapeutic strategies is weak for ND-CKD. We evaluated the patient characteristics, treatment patterns and PTH control over the first year of haemodialysis (HD) by PTH prior to HD initiation. Methods We studied 5683 incident HD patients from 21 countries in Dialysis Outcomes and Practice Patterns Study Phases 4–6 (2009–18). We stratified by PTH measured immediately prior to HD initiation and reported the monthly prescription prevalence of active vitamin D and calcimimetics over the first year of HD and risk of PTH &gt;600 pg/mL after 9–12 months on HD. Results The 16% of patients with PTH &gt;600 pg/mL prior to HD initiation were more likely to be prescribed active vitamin D and calcimimetics during the first year of HD. The prevalence of PTH &gt;600 pg/mL 9–12 months after start of HD was greater for patients who initiated HD with PTH &gt;600 (29%) versus 150–300 (7%) pg/mL (adjusted risk difference: 19%; 95% confidence interval : 15%, 23%). The patients with sustained PTH &gt;600 pg/mL after 9–12 months on HD were younger, more likely to be black, and had higher serum phosphorus and estimated glomerular filtration rates at HD initiation. Conclusions Increased PTH before HD start predicted a higher PTH level 9–12 months later, despite greater use of active vitamin D and calcimimetics. More targeted PTH control during ND-CKD may influence outcomes during HD, raising the need for PTH target guidelines in these patients.

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