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Natives und aktives Vitamin D

Native and active vitamin D

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Viele Patienten mit chronischer Nierenerkrankung (CKD) weisen einen Vitamin-D-Mangel oder eine Vitamin-D-Insuffizienz (Serum-25-Hydroxyvitamin-D <30 ng/ml) auf. Eine Substitution mit nativem Vitamin D in einen normalen bis hochnormalen Bereich (30–50 ng/ml) erscheint klinisch sicher und dürfte zumindest in früheren CKD-Stadien (aber wohl nicht bei CKD-5D) eine gewisse PTH-supprimierende Wirkung aufweisen. Calcitriol und aktive Vitamin-D-Analoga haben bei CKD-Patienten (Stadien 3–5D) gesicherte Wirkungen bei der Therapie des sekundären Hyperparathyreoidismus (sHPT) und damit verbundener ossärer Veränderungen. Klinisch relevante Unterschiede zwischen den aktiven Vitamin-D-Therapeutika wurden bisher nicht nachgewiesen. Nichtkalziotrope (pleiotrope) Vitamin-D-Wirkungen werden weiter intensiv diskutiert. Neueren Daten zufolge könnte ein Vitamin-D-Mangel mit akzelerierter renaler Progression assoziiert sein. Als ein möglicher pathogenetischer Mechanismus wurde eine Reduktion der Proteinurie durch aktives Vitamin D (Paricalcitol) postuliert. Ein Vitamin-D-Mangel ist bei CKD-Patienten mit erhöhter (kardiovaskulärer) Mortalität und Morbidität assoziiert; die Therapie mit aktiven Vitamin-D-Verbindungen ist bei CKD mit niedrigerer Mortalität verbunden. Kausale Zusammenhänge sind bei CKD-Patienten jedoch bisher nicht nachgewiesen.

Abstract

Vitamin D deficiency or insufficiency (defined as serum 25-hydroxyvitamin D levels <30 ng/ml) is frequent in chronic kidney disease (CKD) patients. Supplementation with native vitamin D to achieve high-normal levels (30–50 ng/ml) appears to be clinically safe and results in moderate parathyroid hormone (PTH) suppression, at least in earlier CKD stages but apparently not in CKD 5D. The therapeutic effects of calcitriol and active vitamin D analogs on secondary hyperparathyroidism (sHPT) and hyperparathyroid bone disease are well documented but clinically relevant differences between the various active vitamin D therapeutics have not yet been demonstrated. Noncalciotropic (pleiotropic) effects of the vitamin D system continue to be widely discussed. Newer data suggest that vitamin D deficiency may be related to accelerated renal progression, and one possible pathogenetic mechanism may be reduction of proteinuria by active vitamin D (paricalcitol). In CKD, vitamin D deficiency is associated with increased (cardiovascular) morbidity and mortality and active vitamin D therapy is associated with lower mortality in CKD; however, causal relationships in CKD patients have not yet been demonstrated.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Vortrags- oder Beratungshonorare von Amgen, Shire und TEVA Deutschland.

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  1. Nephrologisches Zentrum, Schramberger Str. 28, 78054, Villingen-Schwenningen, Deutschland

    H. Reichel

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Reichel, H. Natives und aktives Vitamin D. Nephrologe 8, 50–55 (2013). https://doi.org/10.1007/s11560-012-0651-x

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  • DOI: https://doi.org/10.1007/s11560-012-0651-x

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