The activation of vitamin D receptors (VDR) - (including activation by 25-hydroxyvitamin D) - seems to have
not only mineral-metabolism beneficial effects but also important extra-skeletal actions. Paricalcitol is a synthetic vitamin
D2 agonist of the VDR approved for the prevention and treatment of secondary hyperparathyroidism associated with
chronic kidney disease (CKD). As a result of its selectivity, paricalcitol provides a wider therapeutic window for PTH
suppression, minimizing deleterious effects of high serum calcium and/or phosphate concentrations. Paricalcitol also
shares, and sometimes improves pleiotropic vitamin-D related systemic effects. For instance, paricalcitol has been repeatedly
shown to decrease calcium and phosphate deposition in vessels and to decrease the expression of osteogenic factors
preventing the active transformation of smooth muscle vascular cells into osteoblast-like cells in experimental models. In
patients, paricalcitol has been associated with improved survival of dialysis patients and it may improve residual albuminuria
in diabetic patients. Consequently, paricalcitol may enhance the standard of care in these high-risk patients. Although
it seems reasonable to use these potential advantages to guide the individual and integral management of the complex
CKD-mineral and bone disorder, it is necessary to recognize that many of these observations have not been proven nor
confirmed in prospective clinical trials.
Keywords: Chronic kidney disease, CKD-MBD, paricalcitol, PTH, vascular calcification, vitamin D.
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