nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2021-3-330-351nid-36Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESРецептор витамина D: новая терапевтическая мишень при заболевании почекThe vitamin D receptor - a new therapeutic target for kidney diseaseВолгинаГ. В.VolginaG. V.volginagv@mail.ruМихайловаН. А.MichailovaN. A.noemail@neicon.ruКотенкоО. Н.KotenkoO. N.noemail@neicon.ruФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова МЗ РФ»РоссияA.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationГБОУ ВПО Российская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Postgraduate EducationRussian FederationГБУЗ Городская клиническая больница № 52 Департамента здравоохранения г. МосквыРоссияCity Clinical Hospital № 52Russian Federation202121062024233330351Copyright © Волгина Г.В., Михайлова Н.А., Котенко О.Н., 20242024Волгина Г.В., Михайлова Н.А., Котенко О.Н.Volgina G.V., Michailova N.A., Kotenko O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/36

Витамин D - стероидный гормон (D-гормон) давно известен своей важной ролью в регуляции минерального обмена, минерализации костей и функционировании паращитовидных желез (ПЩЖ). Установлено, что дефицит витамина D (25(OH)D) является одним из факторов риска развития различных заболеваний, таких как сердечно-сосудистая патология, сахарный диабет, ожирение, злокачественные новообразования в общей популяции, но его связь с заболеваемостью и смертностью пациентов с хронической болезнью почек (ХБП) недостаточно изучена. Интерес нефрологов к активному метаболиту витамина D (VD) и его влиянию за пределами классических эффектов возрос за последние несколько лет, что обусловлено фактом обнаружения специфических рецепторов VD (VDR), локализованных в ядрах клеток многих органов и тканей, не связанных с минеральным обменом. Это резко изменило понимание роли, которую играют VDR, и последствия их активации. В ряде исследований были проанализированы отличия различных активаторов (агонистов) VDR и предложена новая концепция селективной активации VDR. Спектр опосредованных D-гормоном эффектов был расширен до плейотропных экстраскелетных действий. В настоящем обзоре мы подробно освещаем физиологию витамин D и влияние на неё многочисленных эндогенных и экзогенных факторов. Отдельно обсуждаются нарушения обмена витамина D при различных стадиях ХБП, тесная взаимосвязь активации VDR, секреции FGF23 и уровня α-Клото. В разделе, посвященном роли активаторов VDR в лечении вторичного гиперпаратиреоза, рассмотрены возможности всего спектра существующих метаболитов витамина D в подавлении секреции паратгормона и влиянии на уровни кальция и фосфора. Приведены результаты недавних метаанализов, сравнивающих эффективность и безопасность селективных и неселективных активаторов VDR (aVDR). Наконец, мы представили достижения в новых областях терапевтического применения селективного активатора VDR парикальцитола как рено- и кардиопротектора, а также привели доводы о потенциальной роли в профилактике различных хронических неинфекционных заболеваний у пациентов с ХБП.

Vitamin D is a steroid hormone (D-hormone) long known for its important role in the regulation of mineral metabolism, bone mineralization and the functioning of the parathyroid glands (PTH). It has been established that vitamin D (25(OH)D) deficiency is one of the risk factors for the development of various diseases, such as cardiovascular pathology, diabetes mellitus, obesity, malignant neoplasms in the general population, but its relationship with the morbidity and mortality of patients with chronic kidney disease (CKD) is not well understood. The interest of nephrologists in the active metabolite of vitamin D (VD) and its influence beyond the classical effects have increased over the past few years, due to the fact of the discovery of specific VD receptors (VDR) localized in the nuclei of cells of many organs and tissues that are not associated with mineral metabolism. In recent years, the understanding of the role played by VDRs and the consequences of their activation has changed dramatically. Several studies have analyzed the differences between various VDR activators (agonists) and proposed a new concept for selective VDR activation. The spectrum of D-hormone-mediated effects has been extended to pleiotropic extraskeletal actions. In this review, we cover in detail the physiology of vitamin D and the effect of numerous endogenous and exogenous factors on it. We separately discussed the metabolic disbalance of vitamin D in different stages of CKD, a close link between it and FGF23 secretion and the level of α-Klotho. In the section on the role of VDR activators in secondary hyperparathyroidism treatment, we looked at the possibilities of the full spectrum of vitamin D metabolites in PTH secretion suppression and influences on calcium and phosphorus serum levels. Here are the results of recent meta-analyses comparing efficiency and safety selective and non-selective VDR activators. Finally, we presented advances in new areas of therapeutic use selective VDR activator paricalcitol as reno- and cardioprotector and also argued for its potential role in the prevention of different chronic non-infectious diseases in patients with CKD.

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The authors declare that there are no conflicts of interest present.