nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2026-1-46-60nid-3984Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОсобенности кальций-фосфорного обмена и метаболизма витамина D у пациентов с хронической болезнью почек на предиализных стадиях на фоне болюсной терапии колекальцифероломFeatures of calcium-phosphorus metabolism and vitamin D metabolism in patients with chronic kidney disease at predialysis stages during bolus cholecalciferol therapyhttps://orcid.org/0009-0007-0513-498XБондаренкоА. С.BondarenkoA. S.

Бондаренко Аксения Сергеевна – аспирант отделения остеопороза и остеопатий.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Axenia S. Bondarenko.

11, Dmitry Ulyanov Street, Moscow, 117292

axenia.bondarenko@gmail.comhttps://orcid.org/0000-0001-7041-0732РожинскаяЛ. Я.RozhinskayaL. Ya.

Рожинская Людмила Яковлевна – д‑р мед. наук, профессор, главный научный сотрудник отделения остеопороза и остеопатий.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Liudmila Ya. Rozhinskaya.

11, Dmitry Ulyanov Street, Moscow, 117292

lrozhinskaya@gmail.comhttps://orcid.org/0000-0002-2729-9386ЖуковА. Ю.ZhukovA. Yu.

Жуков Артём Юрьевич – канд. мед. наук, руководитель МАСЦ.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Artem Yu. Zhukov.

11, Dmitry Ulyanov Street, Moscow, 117292

zhukovartem@yahoo.comhttps://orcid.org/0000-0001-9002-1662ИоутсиВ. A.IoutsiV. A.

Иоутси Виталий Алексеевич – канд. хим. наук, заведующий лабораторией метаболомных и протеомных исследований.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Vitaliy A. Ioutsi.

11, Dmitry Ulyanov Street, Moscow, 117292

ioutsi.vitalij@endocrincentr.ruhttps://orcid.org/0000-0001-7879-2034ОвчаровМ. В.OvcharovM. V.

Овчаров Максим Викторович – канд. хим. наук, научный сотрудник лаборатории метаболомных и протеомных исследований.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Maksim V. Ovcharov.

11, Dmitry Ulyanov Street, Moscow, 117292

ovcharov.maksim@endocrincentr.ruhttps://orcid.org/0000-0002-8698-0681КолесниковаГ. С.KolesnikovaG. S.

Колесникова Галина Сергеевна – д‑р биол. наук, главный научный сотрудник клинико‑диагностической лаборатории.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Galina S. Kolesnikova.

11, Dmitry Ulyanov Street, Moscow, 117292

Kolesnikova.Galina@endocrincentr.ruhttps://orcid.org/0009-0005-3273-6930СлепцоваА. И.SleptsovaA. I.

Слепцова Арина Игоревна – научный сотрудник клинико‑диагностической лаборатории.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Arina I. Sleptsova.

11, Dmitry Ulyanov Street, Moscow, 117292

sleptsova.arina@endocrincentr.ruhttps://orcid.org/0000-0003-3838-8285ТрубицынаН. П.TrubitsynaN. P.

Трубицына Наталья Петровна – канд. мед. наук, ведущий научный сотрудник отделения диабетической болезни почек и посттрансплантационной реабилитации.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Natalia P. Trubitsyna.

11, Dmitry Ulyanov Street, Moscow, 117292

trubicina@mail.ruhttps://orcid.org/0000-0002-2499-4770ВиноградовВ. Е.VinogradovV. E.

Виноградов Владимир Евгеньевич – врач‑нефролог, зав. консультативно‑диагностическим нефрологическим отделением.

123182, Москва, ул. Пехотная, д. 3

Vladimir E. Vinogradov.

3, Pekhotnaya Street, Moscow, 123182

nephrocentr52@mail.ruhttps://orcid.org/0000-0001-8264-7374КотенкоО. Н.KotenkoO. N.

Котенко Олег Николаевич – д‑р мед. наук, главный внештатный специалист нефролог ДЗМ, руководитель Научно‑практического центра нефрологии и патологии трансплантированной почки.

123182, Москва, ул. Пехотная, д. 3

Oleg N. Kotenko.

3, Pekhotnaya Street, Moscow, 123182

olkotenko@yandex.ruhttps://orcid.org/0000-0001-6539-466XПигароваЕ. А.PigarovaE. A.

Пигарова Екатерина Александровна – д‑р мед. наук, ведущий научный сотрудник отделения нейроэндокринологии, Директор Института высшего и дополнительного профессионального образования ГНЦ РФ ФГБУ «НМИЦ эндокринологии им. академика И.И. Дедова» Минздрава России.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Ekaterina A. Pigarova.

11, Dmitry Ulyanov Street, Moscow, 117292

kpigarova@gmail.comhttps://orcid.org/0000-0002-6674-6441БелаяЖ. Е.BelayaZh. E.

Белая Жанна Евгеньевна – д‑р мед. наук, профессор, заведующая отделением остеопороза и остеопатии.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Zhanna E. Belaya.

11, Dmitry Ulyanov Street, Moscow, 117292

jannabelaya@gmail.comhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна – д‑р мед. наук, профессор, академик РАН, директор ГНЦ РФ ФГБУ «НМИЦ эндокринологии им. академика И.И. Дедова» Минздрава России.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Natalia G. Mokrysheva.

11, Dmitry Ulyanov Street, Moscow, 117292

parathyroid.enc@gmail.comГНЦ РФ ФГБУ «НМИЦ эндокринологии им. академика И.И. Дедова» Минздрава РоссииРоссияEndocrinology Research CentreRussian FederationГБУЗ «МКНИЦ больница № 52 ДЗМ»РоссияState Clinical Research and Practical Center “City Clinical Hospital No. 52” of the Moscow Department of HealthRussian Federation2026010420262814660Copyright © Бондаренко А.С., Рожинская Л.Я., Жуков А.Ю., Иоутси В.A., Овчаров М.В., Колесникова Г.С., Слепцова А.И., Трубицына Н.П., Виноградов В.Е., Котенко О.Н., Пигарова Е.А., Белая Ж.Е., Мокрышева Н.Г., 20262026Бондаренко А.С., Рожинская Л.Я., Жуков А.Ю., Иоутси В.A., Овчаров М.В., Колесникова Г.С., Слепцова А.И., Трубицына Н.П., Виноградов В.Е., Котенко О.Н., Пигарова Е.А., Белая Ж.Е., Мокрышева Н.Г.Bondarenko A.S., Rozhinskaya L.Y., Zhukov A.Y., Ioutsi V.A., Ovcharov M.V., Kolesnikova G.S., Sleptsova A.I., Trubitsyna N.P., Vinogradov V.E., Kotenko O.N., Pigarova E.A., Belaya Z.E., Mokrysheva N.G.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/3984Введение

Введение. Хроническая болезнь почек (ХБП) сопровождается нарушением регуляции кальций-фосфорного обмена и метаболизма витамина D, приводящим к развитию минеральных и костных нарушений (МКН-ХБП). Патогенетические особенности этих изменений на предиализных стадиях ХБП и эффекты высокодозной терапии колекальциферолом остаются недостаточно охарактеризованными.

Цель

Цель. Провести сравнительный анализ метаболитов витамина D и показателей кальций-фосфорного обмена у пациентов с ХБП на предиализных стадиях и у лиц без нарушения функции почек, а также оценить их динамику после однократного болюсного приёма 150 000 МЕ колекальциферола.

Материалы и методы

Материалы и методы. В исследование включены 58 участников: 23 пациента с ХБП С3, 14 – с ХБП С4-5 и 21 человек группы сравнения. Лабораторное обследование с определением показателей кальций-фосфорного обмена и метаболитов витамина D проводилось исходно и через 7 дней после однократного приема водного раствора колекальциферола в дозе 150 000 МЕ. Концентрации метаболитов витамина D определялись методом ВЭЖХ-МС/МС.

Результаты

Результаты. Значения показателей представлены в порядке: группа сравнения, ХБП С3, ХБП С4-5. Исходно у пациентов с ХБП отмечались более высокие уровни ПТГ (51,3 [40,6; 62,7] vs 70,9 [49,0; 105,9] vs 101,0 [91,7; 120,1] пг/мл), снижение кальцитриола (40,9 [34,3; 59,4] vs 25,0 [19,8; 29,1] vs 26,4 [13,8; 30,6] пг/мл), тенденция к повышению ФРФ-23 (0,73 [0,43; 1,07] vs 1,08 [0,61; 2,52] vs 3,22 [1,78; 4,51] пмоль/л) и снижение соотношения 24,25(OH)2D3/25(OH)D3 (0,06 [0,04; 0,08] vs 0,03 [0,01; 0,04] vs 0,03 [0,02; 0,04]), отражающее возможное нарушение активности 24-гидроксилазы. Уровни общего и свободного 25(OH)D, а также витамин-D-связывающего белка (VDBP) между группами не различались.

Через 7 дней после приёма колекальциферола отмечался сопоставимый прирост общего 25(OH) D3, 3-epi-25(OH)D3 и 24,25(OH)2D3 во всех группах. У пациентов с ХБП С3 и С4-5 прирост свободного 25(OH)D был статистически значимо ниже, чем в группе сравнения (p=0,036 и p=0,028). В группе ХБП С3 отмечалось снижение ПТГ (p=0,039), тогда как при ХБП С4-5 – повышение ФРФ-23 (p=0,042). Уровни кальция, фосфора, кальцитриола и VDBP не изменялись.

Заключение

Заключение. Изменения кальций-фосфорного обмена и метаболизма витамина D на предиализных стадиях ХБП носят последовательный характер. Снижение процессов активации и инактивации витамина D, повышение ФРФ-23 и менее выраженный прирост свободного 25(OH)D после болюсного приёма колекальциферола указывают на особенности регуляции и ограниченную применимость стандартных схем коррекции дефицита витамина D у данной категории пациентов.

Background

Background. Chronic kidney disease (CKD) is associated with disturbances in calcium-phosphate homeostasis and vitamin D metabolism, leading in mineral and bone disorders (CKD-MBD). However, the pathogenetic features of these alterations at predialysis CKD stages and the effects of high-dose cholecalciferol therapy remain insufficiently characterized.

Objective

Objective. To compare vitamin D metabolites and calcium-phosphate metabolism parameters in patients with predialysis CKD and individuals without impaired kidney function, and to assess their dynamics after a single bolus dose of 150,000 IU of cholecalciferol.

Materials and Methods

Materials and Methods. The study included 58 participants: 23 patients with CKD stage C3, 14 with CKD stages C4-5, and 21 controls. Parameters of calcium-phosphate metabolism and vitamin D metabolites were assessed at baseline and 7 days after a single oral dose of aqueous cholecalciferol (150,000 IU). Vitamin D metabolites were measured using LC–MS/MS.

Results

Results. Data are presented as follows: control group, CKD C3, CKD C4-5. At baseline, CKD patients had higher parathyroid hormone (PTH) levels (51.3 [40.6; 62.7] vs 70.9 [49.0; 105.9] vs 101.0 [91.7; 120.1] pg/mL), lower calcitriol concentrations (40.9 [34.3; 59.4] vs 25.0 [19.8; 29.1] vs 26.4 [13.8; 30.6] pg/mL), a trend toward higher fibroblast growth factor 23 (FGF-23) levels (0.73 [0.43; 1.07] vs 1.08 [0.61; 2.52] vs 3.22 [1.78; 4.51] pmol/L), and a reduced 24,25 (OH)2D3/25(OH)D3 ratio (0.06 [0.04; 0.08] vs 0.03 [0.01; 0.04] vs 0.03 [0.02; 0.04]), indicating impaired 24-hydroxylase activity. Total and free 25(OH)D levels and vitamin D-binding protein (VDBP) were comparable between groups.

Seven days after cholecalciferol administration, a similar increase in total 25(OH)D3, 3-epi-25(OH)D3, and 24,25(OH)2D3 was observed in all groups. However, the increase in free 25(OH)D was significantly smaller in CKD C3 and C4-5 compared with controls (p=0.036 and p=0.028). PTH decreased in CKD C3 (p=0.039), whereas FGF-23 increased in CKD C4-5 (p=0.042). Serum calcium, phosphorus, calcitriol, and VDBP remained unchanged.

Conclusion

Conclusion. Alterations in calcium-phosphate and vitamin D metabolism at predialysis CKD stages show a sequential pattern. Reduced vitamin D activation and inactivation, increased FGF-23 levels, and a blunted free 25(OH)D response to bolus cholecalciferol indicate specific regulatory features and limit the applicability of standard vitamin D correction regimens in this population.

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