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Sandro Mazzaferro Cattedra di Nefrologia I Facoltà Medicina e Chirurgia Sapienza Università di Roma XV Riunione del GdS DDialisi Peritoneale Bari, 19-20.

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Presentation on theme: "Sandro Mazzaferro Cattedra di Nefrologia I Facoltà Medicina e Chirurgia Sapienza Università di Roma XV Riunione del GdS DDialisi Peritoneale Bari, 19-20."— Presentation transcript:

1 Sandro Mazzaferro Cattedra di Nefrologia I Facoltà Medicina e Chirurgia Sapienza Università di Roma XV Riunione del GdS DDialisi Peritoneale Bari, 19-20 Febbraio 2010 Question Time 2: In DP più vantaggi con la vitamina D o i VDRAs?

2 Why active Vitamin D therapy in PD To suppress PTH: –B–But serum Ca Increases (also Ca balance) –B–But serum P Increases (also P balance) To improve morbidity/mortality: –L–Linked to SH (bone disease/fractures and toxicity) –L–Linked to CV effects of CKD-MBD

3 Bushinsky CJASN 2010

4 Structures of Calcitriol and Paricalcitol HO OH CH 3 CH 2 H3CH3C OH CH 3 H3CH3C OH CH 3 HO Calcitriol 19-nor-1-, 25-dihydroxyvitamin D 2 1-, 25-dihydroxyvitamin D 3 Paricalcitol Induzione VDR Intestino Ca e P da Osso + + _ _

5 6.00 5.50 5.00 4.50 4.00 UREMIC 0N24882575ng Ionized Calcium (mg/dL) * = p<0.02 1.25-(OH) 2 D 3 19-nor-1,25(OH) 2 D 2 * The Effects of 1,25-(OH) 2 D 3 and 19-nor-1,25-(OH) 2 D 2 on Ionized Calcium in Uremic Rats Slatopolsky AJKD 1995

6 Effects of 1,25D-(OH) 2 D 3 and 19-Nor-1,25-(OH) 2 D 2 on Intestinal 1,25-(OH) 2 D 3 –VDR Binding in Uremic Rats Normal Uremic 02625100 ng 1,25-(OH) 2 D 3 19-nor-1,25-(OH) 2 D 2 *p<0.01 vs Uremic+1,25D-6ng * * * 3 H-1,25-(OH) 2 D 3 Specific Binding (fmol/mg protein) Slatopolsky AJKD 1995

7 10 -11 Concentration, M 0 20 40 60 80 100 120 Area Resorbed, % 10 8 1,25D 3 1,25D 3 19-norD 2 Dose-dependent Effects of 1,25D 3 and 19-norD 2 on Osteoclastic Resorption: Area Resorbed 10 -10 10 -9 10 -8 10 -7 10 -6 Holliday S, JASN 11:1857, 2000

8 10 11 Concentration, M 0 20 40 60 80 100 120 Number of Pits, % 10 -8 1,25D 3 1,25D 3 19-norD 2 Dose-dependent Effects of 1,25D 3 and 19-norD 2 on Osteoclastic Resorption: Number of Pits 10 10 9 10 8 10 7 10 6 Holliday S, JASN 11:1857, 2000

9 Serum Calcium and Phosphorus in Placebo and Paricalcitol Treated Patients Weeks 123456789101112 Serum Calcium or Phosphorus mg/dl 0 1 2 3 4 5 6 7 8 9 10 11 ParicalcitolPlacebo Calcium Phosphorus Martin et al. JASN 9: 1427, 1998

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12 Lund et al Am J Neph, 2010 Intestinal Ca Absorption in HD: comparison between Calcitriol and Paricalcitol 22 HD pts; PTH>200pg/ml Calcitriol i.v.; 2ug/HDx6 Paricalcitol i.v.; 6 ug/HDx6

13 Potential advantages of Paricalcitol vs Calcitriol PTH suppression with: – Lower calcemic effect; – Lower phosphate effect; – Better survival To date no RCT is available to clearly demonstrate the last statement.

14 Sanchez NDT 2004 Low vs standard CaD in PD Not all ABD! CaD = 1,75 M CaD = 1,25 M 1 Year!

15 PTH OC Mg No change!! P Ca++ TCa


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