EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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Introduction. Nephroprotective strategy on pre-dialytic stages of chronic kidney disease (CKD) is aimed at maximal reduction of proteinuria (microalbuminuria) and at the same time at blood pressure normalization, as the former and the latter are the most significant factors of glomerulosclerosis progression. Early systematic use of calcitriol combined with blocking agents of renin-angiotensin system (RAS), erythropoietin preparations and hypolipidemic drugs plays an especially important role in proteinuria level reduction.

The research objective was to do a comparative analysis of how calcitriol and paricalcitol affect proteinuria level reduction and prophylaxis of secondary hyperparathyreosis (SHPT) in patients with systemic illnesses and ^rd or 4^th stage of CKD.

Patients and methods. 50 patients with 3^rd or 4^th stage of CKD caused by systemic illnesses (in 35 cases by systemic lupus erythematosus, 15 cases - by various forms of systemic vasculitis) were included in the research. They were divided into 2 groups. The 1^st group consisted of 28 patients (8 with the 3^rd stage and 20 with the 4^th stage), they were given 0,25 µg of calcitriol per day. The 2^nd group consisted of 22 patients (9 with the 3^rd stage and 13 with the 4^th stage), they were prescribed to take 1 µg of paricalcitol per day. Calcitriol and paricalcitol were used for nephroprotection at intact parathyroid hormone (PTH) level in blood over 65 pg/ml with allowance for phosphocalcium metabolism characteristics. Patients of both groups were prescribed blocking agents RAS, erythropoietin preparations, iron prepaprations and statins. 11 patients of the 1^st group and 12 patients of the 2^nd group underwent Doppler ultrasound examination of carotid arteries at the beginning and at the end of the research period.

Results. Before calcitriol and paricalcitol treatment proteinuria level made up 1,2±0,6 g/day in the 1^st group and 1,3±0,4 g/day in the 2^nd group, while intact PTH level was correspondingly 75±17,4 pg/ml and 80±16,6 pg/ml. Combined affection of carotid arteries with calcinosis/ atherosclerosis was detected in 27,3% of patients in the 1^st group and 33,3% of patients in the 2^nd group.

The patients tolerated calcitriol and paricalcitol quite well. As a result, after three months of this treatment intact PTH level became normal in those patients who originally had the high level. In the patients who took paricalcitol, proteinuria level dropped faster (p< 0,05) and arterial hypertension abated to a greater extent (p<0,01) than in those who took calcitriol. Within the same period neither hypercalcemia nor advance of calcinosis/ atherosclerosis were detected in 4 patients of the 2^nd group with calcinosis/ atherosclerosis. Among the patients who took calcitriol, on the contrary, hypercalcemia was detected in 27,3% of patients, advance of calcinosis/ atherosclerosis – in 3 patients who had been diagnosed with calcinosis/ atherosclerosis during screening.

Conclusion. Use of paricalcitol on pre-dialytic stages of CKD caused by systemic illnesses with hyperparathyreosis leads not only to normalization of intact PTH level but to evidential abatement of daily proteinuria and arterial hypertension.