Selective vitamin D receptor activator Paricalcitol and its potential benefits in hemodialysis patients with secondary hyperparathyroidism

Currently, the incidence and prevalence of chronic kidney disease (CKD) are increasing annually worldwide, and clinical data show that CKD patients commonly experience relative vitamin D insufficiency or deficiency. Secondary hyperparathyroidism (SHPT) is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients. SHPT is an adaptive and in many cases ultimately maladaptive process that develops in response to declining kidney function, impaired phosphate excretion, failure to bioactivate vitamin D and hypocalcemia. SHPT is characterized by persistently elevated levels of parathyroid hormone (PTH) and complicated by important disturbances in mineral metabolism. Maintaining the level of vitamin D and parathyroid hormone concentrations in the target range reduce its associated complications (e.g., fractures, chronic kidney disease and cardiovascular calcification). Effective therapeutic interventions are highly desirable if the morbidity and mortality associated with uncontrolled SHPT are to be reduced. Major renal guidelines recommend use of vitamin D for secondary hyperparathyroidism in chronic kidney disease. However, because of the difficulties associated with lowering PTH while simultaneously controlling serum levels of calcium and phosphorous, traditional therapies for managing SHPT have several limitations. Selective vitamin D receptor activator paricalcitol mainly targets vitamin D receptors (VDR) in the parathyroid glands, has less effect on VDR in the intestine and other tissues, inhibits PTH strongly, triggers less hypercalcemia, and has less effect on intestinal absorption of calcium, phosphorus and bone metabolism and significantly lowers renin levels, albuminuria and blood pressure, which is supported by the results of most studies conducted over these decades. The article is devoted to the problem of treatment of patients with SHPT inpatient with renal replacement therapy with program hemodialysis

The role of the gut microbiota in the development of type 1 diabetes mellitus

At the beginning of the XXI century, with the advent of technical capabilities and new methods of genes sequencing, the attention of researchers to the study of the human metagenome has significantly increased. The interaction between changes in the qualitative and quantitative composition of the gut microbiota (GM) and various diseases is being actively studied, a search for specific metabolites and genes of microorganisms that may be associated with the development, in particular, of immune-mediated diseases is underway. In recent years, a lot of new data have been published on the possible contribution of gut flora dysbiosis to the development of Type 1 Diabetes Mellitus (T1DM), while the first assumptions were put forward as far back as 1970s. The search for pathogenetic mechanisms of GM influence on the development and progression of T1DM is becoming an increasingly relevant objective, since in recent years the incidence of T1DM is rapidly increasing, which is a serious health problem throughout the world.This review discusses the current ideas about the role of GM in the immunopathogenesis of T1DM, new data on the near-term prospects in the study of the human macrogenome, current ideas about the role of GM in the immunopathogenesis of T1DM, and the possibility of applying this knowledge by the practitioner

Quality Management System in Stavropol Research Anti-Plague Institute

The analysis of the structure of quality management system and the areas of its activity is presented. Trends for its further improvement are defined

MEDICAL METHODS OF CORRECTION OF RENAL OSTEODYSTROPHY

The article presents a literature review summarizing the contemporary data on the effects of drug therapy on various parameters of renal osteodystrophy: phosphate binders, vitamin D preparations, bisphosphonates, denosumab, and calcimimetics. We discuss the results of pilot study of the efficacy of teriparatide and denosumab on parameters of bone metabolism in patients with chronic kidney disease

VLIYaNIE TsINAKALTsETA (MIMPARY) NA POChEChNUYu OSTEODISTROFIYu U PATsIENTOV, NAKhODYaShchIKhSYa NA PROGRAMMNOM GEMODIALIZE

В статье представлен обзор современной литературы и результаты наших исследований, обобщающие экспериментальные и клинические данные о влиянии цинакалцета на гормонально-биохимические показатели фосфорно-кальциевого обмена, на маркеры костного метаболизма, минеральную плотность костей, также на гистоморфометрические показатели почечной остеодистрофии у гемодиализных пациентов с вторичным гиперпаратиреозо

GUT ENTEROBIOTA — A NEW PLAYER IN ATHEROSCLEROSIS PATHOGENESIS

The article provides a review of contemporary literature, which generalizes experimental and clinical data on the role of gut microbiota in atherosclerosis development. Gut microflora can be named a marker of the macroorganism condition, reacting on age-related, physiological, dietic, climatogeoraphic factors with its changes of qualitative and quantitative compounds. It was shown that L-carnitine and choline being received with food, are utilized by microflora to synthetize trimethylamine, which then rapidly oxydized by flavinmonooxygenase of liver to trimethylamin-N-oxide, that causes atherosclerosis development and increases risk of cardiovscular diseases

PLEIOTROPIC EFFECTS OF PARATHYROIDECTOMY AND AGONIST CALCIUM-SENSITIVE RECEPTOR, CINACALCET

Aim. To evaluate the effect of parathyroidectomy and cinacalcet on anemia, lipid profile and blood pressure (BP) in uremic hyperparathyroidism.Material and methods. Uremic patients (n=39) treated with hemodialysis and having secondary hyperparathyroidism were included into the study. Radical parathyroidectomy was performed in 21 patients, 18 patients were treated with cinacalcet. BP measurement, determination of blood levels of albumin, total calcium, phosphorus, total cholesterol (TC), low (LDL) and high density lipoproteins, triglycerides, intact parathyroid hormone, and hemoglobin were performed in all patients initially and during treatment. Doses of antihypertensive and erythropoiesis-stimulating agents were also assessed.Results. Calcium-phosphorus metabolism indices improved after 6 months of cinacalcet therapy and parathyroidectomy (p<0.05). BP reduction not requiring antihypertensive drugs dose adjustment was found in patients treated with cinacalcet. Significant BP reduction (p<0.05) was observed after parathyroidectomy and it required antihypertensive drugs cancellation or dose lowering. Cinacalcet therapy and parathyroidectomy led to increase in hemoglobin level by 2.02% (p=0.143) and 7.6% (p=0.029), respectively, as well as reduction in weekly dose of erythropoiesis-stimulating drugs by 2.7% (p=0.875) and 8.9% (p=0.751), respectively. Significant (p<0.05) decrease in LDL (5.6%), and triglycerides (23.7%) levels was found in patients treated with cinacalcet. Reduction (p<0.05) in total cholesterol (1.4%) and LDL (4.3%) levels was observed after parathyroidectomy.Conclusion. The pleiotropic effects (reduction in BP and atherogenic lipids levels, as well as decrease in anemia resistant to the action of erythropoiesis-stimulating agents) were found after parathyroidectomy and cinacalcet therapy additionally to calcium-phosphorus metabolism improvement

PLEIOTROPIC EFFECTS OF PARATHYROIDECTOMY AND AGONIST CALCIUM-SENSITIVE RECEPTOR, CINACALCET

Aim. To evaluate the effect of parathyroidectomy and cinacalcet on anemia, lipid profile and blood pressure (BP) in uremic hyperparathyroidism.Material and methods. Uremic patients (n=39) treated with hemodialysis and having secondary hyperparathyroidism were included into the study. Radical parathyroidectomy was performed in 21 patients, 18 patients were treated with cinacalcet. BP measurement, determination of blood levels of albumin, total calcium, phosphorus, total cholesterol (TC), low (LDL) and high density lipoproteins, triglycerides, intact parathyroid hormone, and hemoglobin were performed in all patients initially and during treatment. Doses of antihypertensive and erythropoiesis-stimulating agents were also assessed.Results. Calcium-phosphorus metabolism indices improved after 6 months of cinacalcet therapy and parathyroidectomy (p&lt;0.05). BP reduction not requiring antihypertensive drugs dose adjustment was found in patients treated with cinacalcet. Significant BP reduction (p&lt;0.05) was observed after parathyroidectomy and it required antihypertensive drugs cancellation or dose lowering. Cinacalcet therapy and parathyroidectomy led to increase in hemoglobin level by 2.02% (p=0.143) and 7.6% (p=0.029), respectively, as well as reduction in weekly dose of erythropoiesis-stimulating drugs by 2.7% (p=0.875) and 8.9% (p=0.751), respectively. Significant (p&lt;0.05) decrease in LDL (5.6%), and triglycerides (23.7%) levels was found in patients treated with cinacalcet. Reduction (p&lt;0.05) in total cholesterol (1.4%) and LDL (4.3%) levels was observed after parathyroidectomy.Conclusion. The pleiotropic effects (reduction in BP and atherogenic lipids levels, as well as decrease in anemia resistant to the action of erythropoiesis-stimulating agents) were found after parathyroidectomy and cinacalcet therapy additionally to calcium-phosphorus metabolism improvement.</p

THE ROLE OF VITAMIN D IN THE PATHOGENESIS OF CHRONIC NON-COMMUNICABLE DISEASES

This review shows the role of vitamin D in the regulation of not only the level of calcium, but also in the pathogenesis of chronic systemic inflammation, disruption of insulin sensitivity of tissues. The sufficient levels of vitamin D in the blood can lead to reduced risk of developing type 2 diabetes, obesity, autoimmune destruction of pancreatic β-cells, certain cardiometa-bolic risk factors, and therefore cardiovascular disease. Perhaps preparations of vitamin D in the near future may become additional and necessary nutritional substances for correction of insulin resistance, cardiovascular disease, chronic inflammation and prevention of disorders of glucose metabolism