SciELO - Scientific Electronic Library Online

 
vol.33 número1Paricalcitol reduce la proteinuria pero no modifica las pérdidas proteicas peritoneales en pacientes en diálisis peritonealAnálisis repetido de la resistencia insulínica estimada mediante índice HOMAIR en pacientes no diabéticos en diálisis peritoneal y su relación con la enfermedad cardiovascular y mortalidad índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados

Revista

Articulo

Indicadores

Links relacionados

  • En proceso de indezaciónCitado por Google
  • No hay articulos similaresSimilares en SciELO
  • En proceso de indezaciónSimilares en Google

Compartir


Nefrología (Madrid)

versión On-line ISSN 1989-2284versión impresa ISSN 0211-6995

Resumen

PINERA-HACES, Celestino et al. Double treatment with paricalcitol-associated calcifediol and cardiovascular risk biomarkers in haemodialysis. Nefrología (Madr.) [online]. 2013, vol.33, n.1, pp.77-84. ISSN 1989-2284.  https://dx.doi.org/10.3265/Nefrologia.pre2012.Sep.11533.

Background: The deficit of 25-hydroxyvitamin D (25OHD) associated with secondary hyperparathyroidism (SHPT) are frequent findings in patients with chronic kidney disease (CKD) on hemodialysis (HD). These events are associated with increased morbidity and mortality of cardiovascular (CV). 25OHD adequate serum levels as well as the use of selective activators of the vitamin D receptor (AsRVD) have been shown to have beneficial effects on bone metabolism and mineral and cardiovascular risk independently. Currently there is still controversy regarding the type of supplementation needed by patients with CKD on HD. Aims: The aim of our study was to evaluate whether there is benefit in combination therapy with 25OHD, calcifediol and a AsRVD, oral paricalcitol on bone-mineral metabolism and inflammatory markers, compared to single treatment with each of them in a group HD patients. Material and methods: A prospective study of 6 months, over 26 patients in our HD unit. We randomized patients into two groups: group 1 (G1) received oral paricalcitol treatment at doses of 1mcg/day. Group 2 (G2) was treated with 1 ampoule calcifediol/wk (0.266mg/wk=16.000U) orally. After 3 months of treatment, was added to the G1 and G2 calcifediol and paricalcitol respectively at the same doses, keeping these treatments together for 3 months to complete the 6 months follow up. Laboratory tests were performed at months 0, 3 and 6, measuring in all patients serum markers of 25OHD, calcium (Ca), phosphorus (P) and PTH Bone turnover markers were: alkaline phosphatase (FA), aminoterminal propeptide of procollagen type 1 (Pinp1) and carboxyl-terminal telopeptide of type I collagen (CrossLaps) and inflammatory markers : IL-8. WE also collected data on levels of insulin, glucose, hemoglobin, erythropoietic agents (ESAs) and rates of resistance to EPO and HOMA (homeostasis model assessment). Results: We detected a deficit of 25-hydroxyvitamin D in all patients studied, with a mean of 13.67±4.81ng/ml. Supplementation with oral calcifediol significantly corrects this deficit without evidence of toxicity (35.36±33.68ng/ml in G1 at 6 months and 59.21±26.50ng/ml in G2 at 3 months). Paricalcitol treatment significantly reduces PTH levels in G1 at 3 months (P<.039). We also noted a decrease in bone marker Pinp1 with paricalcitol, pointing to a possible direct effect on bone cells (P<.001). Both treatment with paricalcitol calcifediol produced a significant decrease in levels of IL-8 (P<.001), known inflammatory marker, drawing attention to a trend towards better response to erythropoiesis-stimulating agents (ESAs), possible related to the decrease in inflammation. The HOMA index did not change significantly. Conclusion: Based on our results, we cannot conclude that the association calcifediol and paricalcitol produces advantages over the effect of each marker separately Paricalcitol also by itself appears to have a direct cellular bone action.

Palabras clave : 25-hydroxyvitamin D; Paricalcitol; Inflammation; Bone-mineral metabolism.

        · resumen en Español     · texto en Español     · Español ( pdf )

 

Creative Commons License Todo el contenido de esta revista, excepto dónde está identificado, está bajo una Licencia Creative Commons