Información de la revista
Vol. 33. Núm. 5.Septiembre 2013
Páginas 623-868
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 33. Núm. 5.Septiembre 2013
Páginas 623-868
Acceso a texto completo
Paricalcitol oral como agente antiproteinúrico en la enfermedad renal crónica
Oral paricalcitol as antiproteinuric agent in chronic kidney disease
Visitas
...
Alberto de Lorenzoa, Alberto de Lorenzob, Laura Salanovaa, Laura Salanovab, Andrew S. Bombackc, Andrew S. Bombackd, María Moyaa, Maria Moyab, Francisco Coronele, Carmen Bernisa, Carmen Bernisb, José A. Sánchez-Tomeroa, José Antonio Sánchez-Tomerob, Vicente Álvareza, Vicente Álvarezb
a Servicio de Nefrolog??a, Hospital Universitario de La Princesa, Madrid, Spain,
b Servicio de Nefrolog??a, Hospital Universitario de La Princesa, Madrid, Madrid, Espa??a,
c Division of Nephrology, Columbia University College of Physicians and Surgeons, Presbyterian Hospital, New York, USA,
d Division of Nephrology, Columbia University College of Physicians and Surgeons, Presbyterian Hospital, New York, New York, USA,
e Servicio de Nefrolog??a, Hospital Clinico Universitario San Carlos, Madrid, Madrid, Espa??a,
Información del artículo

Introducción: La vitamina D posee un efecto regulatorio del eje renina-angiotensina-aldosterona, jugando, por lo tanto, un papel importante en cuanto a proteinuria se refiere. Presentamos nuestra experiencia en el uso de paricalcitol como antiproteinúrico. Métodos: Incluimos 36 pacientes con un eGFR of 30-90 ml/min/1,73 m2 y proteinuria > 400 mg/d con dosis estables de inhibidores del SRAA durante 3 meses. Se le admistró durante 12 meses 1 µg/día de paricalcitol. Como objetivo primario estudiamos el descenso de proteinuria; como secundarios cambios en Cr, eFG, calcio, fósforo, iPTH, 25(OH)vitD, PCR y tension arterial. Resultados: La proteinuria media fue 2806 mg/d cayendo  hasta 2199 mg/d en el mes 6 (p < 0,0001) y 1931,5 mg/d a los 12 meses (p < 0,0001). Aquellos con una proteinuria basal  > 3000 mg/d (n=12) sufrieron una menor disminución (5956,9 ± 2492,6 mg/d a 4220,4 ± 2613 mg/d en mes 12) respecto a aquellos con una proteinuria < 3000 mg/d (1371 ± 627,5 mg/d a 821,3 ± 491,5 mg/d en mes 12). No se objetivaron cambios en tension arterial, eGFR y PCR. Los cambios en calcio, fósforo, iPTH y vitamina D 25(OH) fueron estadísticamente significativos. Conclusión: Nuestro estudio demuestra una reducción importante de proteinuria con dosis bajas de paricalcitol en pacientes con IRC, que es de particular importancia en aquellos con porteinuria basal entre 1-3 g/d.

Palabras clave:
Proteinuria
Palabras clave:
Sistema renina-angiotensina-aldosterona
Palabras clave:
Paricalcitol
Palabras clave:
Enfermedad renal crónica
Palabras clave:
Vitamina D

Background: Vitamin D has an important regulatory effect on the renin-angiotensin-aldosterone system, playing a central role in the regulation of proteinuria. We therefore studied the antiproteinuric effect of paricalcitol. Methods: 36 patients with an estimated GFR of 30-90mL/min/1.73m2 and proteinuria >400mg/d with a stable dose of ACE inhibitor or ARB for at least 3 months were recruited. Patients received oral paricalcitol 1µg/day for 12 months. Primary endpoint was decrease in proteinuria from baseline. Secondary endpoints were changes in creatinine, eGFR, serum levels of calcium, phosphorus, iPTH, 25(OH)vitD, C-Reactive Protein and blood presure. Results: Mean proteinuria was 2806mg/d and fell to 2199mg/d at month 6 (p<.0001) and 1931.5mg/d at month 12 (p<.0001). Patients with >3000mg/d baseline proteinuria (n=12) saw smaller relative reductions in proteinuria (5956.9±2492.6mg/d to 4220.4±2613mg/d at 12 months) than patients with <3000mg/d baseline proteinuria (1371±627.5 mg/d to 821.3±491.5mg/d at 12 months). There were no changes in BP, eGFR and CRP. We observed significant changes in serum levels of calcium, phosphorus, iPTH, 25(OH) vitamin D. Conclusion: Our study shows an important reduction in proteinuria with a low dose of oral paricalcitol in CKD, that is particularly robust with baseline proteinuria between 1-3g/d.

Keywords:
Proteinuria
Keywords:
Renin-angiotensin system
Keywords:
Paricalcitol
Keywords:
Chronic kidney disease
Keywords:
Vitamin D
El Texto completo está disponible en PDF
Bibliografía
[1]
Keane Wf, Eknoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): A position paper of the National Kidney Foundation. Am J Kidney Dis 1999;33:1004-10. [Pubmed]
[2]
de Zeeuw D. Targeting proteinuria as a valid surrogate for individualized kidney protective therapy. Am J Kidney Dis 2008;51:713-6. [Pubmed]
[3]
Yuan W, Pan W, Kong J, Zheng W, Szeto FL, Wong KE, et al. 1,25-Dihydroxyvitamin D3 Suppresses Renin Gene Transcription by Blocking the Activity of the Cyclic AMP Response Element in the Renin Gene Promoter. J Biol Chem 2007;282(41):29821-30.
[4]
Bodyak N, Ayus JC, Achinger S, Shivalingappa V, Ke Q, Chen YS, et al. Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals. Proc Natl Acad Sci U S A 2007;104:16810-5. [Pubmed]
[5]
Levin A, Li YC. Vitamin D and its analogues: do they protect against cardiovascular disease in patients with kidney disease? Kidney Int 2005;68:1973-81. [Pubmed]
[6]
Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004;141:929-37. [Pubmed]
[7]
Wu-Wong JR, Nakane M, Ma J, Ruan X, Kroeger PE. Effects of Vitamin D analogs on gene expression profiling in human coronary artery smooth muscle cells. Atherosclerosis 2006;186:20-8. [Pubmed]
[8]
Szeto C, Chow KM, Kwan BC, Chung KY, Leung CB, Li PK. Oral Calcitriol for the Treatment of Persistent Proteinuria in Immunoglobulin A Nephropathy: An Uncontrolled Trial. Am J Kidney Dis 2008;51(5):724-31. [Pubmed]
[9]
Agarwal R, Acharya M, Tian J, Hippensteel RL, Melnick JZ, Qiu P, et al. Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney Int 2005;68:2823-8. [Pubmed]
[10]
Fishbane S, Chittineni H, Packman M, Dutka P, Ali N, Durie N. Oral Paricalcitol in the Treatment of Patients With CKD and Proteinuria: A Randomized Trial. Am J Kidney Dis 2009;54(4):647-52. [Pubmed]
[11]
Alborzi P, Patel NA, Peterson C, Bills JE, Bekele DM, Bunaye Z, et al. Paricalcitol Reduces Albuminuria and Inflammation in Chronic Kidney Disease: A Randomized Double-Blind Pilot Trial. Hypertension 2008;52:249-55.
[12]
Aperis G, Paliouras C, Zervos A, Arvanitis A, Alivanis P. The role of paricalcitol on proteinuria. J Ren Care 2011;37(2):80-4. [Pubmed]
[13]
de Zeeuw D, Agarwal R, Amdahl M, Audhya P, Coyne D, Garimella T, et al. Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. Lancet 2010;376(9752):1543-51. [Pubmed]
[14]
De Nicola L, Conte G, Russo D, Gorini A, Minutolo R. Antiproteinuric effect of add-on paricalcitol in CKD patients under maximal tolerated inhibition of renin-angiotensin system: a prospective observational study. BMC Nephrol 2012;13:150. [Pubmed]
[15]
Blanco-Garc??a R, Bravo-L??pez JJ, Moreiras-Plaza M, N??jera-de la Garza W, Cossio-Annibar C, Beato-Coo L, et al. Microalbuminuria, another use for paricalcitol? Our experience in advanced chronic kidney disease. Nefrologia 2012;32(3):401-2.
[16]
Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25??Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002;110:229-38.
[17]
Freundlich M, Quiroz Y, Zhang Z, Zhang Y, Bravo Y, Weisinger JR, et al. Suppression of renin-angiotensin gene expression in the kidney by paricalcitol. Kidney Int 2008;74:1394-402. [Pubmed]
[18]
Schmieder RE, Hilgers KF, Schlaich MP, Schmidt BM. Renin-angiotensin system and cardiovascular risk. Lancet 2007;369:1208-19. [Pubmed]
[19]
Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. RENAAL Study Investigators: effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001;345:861-9. [Pubmed]
[20]
The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997;349:1857-63. [Pubmed]
Idiomas
Nefrología

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?