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Calcitriol is a hormone and the active form of vitamin D, normally made in the kidney. [ 8 ] [ 9 ] [ 10 ] It is also known as 1,25-dihydroxycholecalciferol . It binds to and activates the vitamin D receptor in the nucleus of the cell, which then increases the expression of many genes. [ 11 ]
The natural, active form of vitamin D is calcitriol (1,25-dihydroxycholecalciferol). This molecule and other naturally occurring forms of vitamin D, including its precursors and metabolites, have been modified to synthesize pharmaceuticals with potentially greater, or selective, therapeutic actions. [1] [2] [3] [4]
Paricalcitol (chemically it is 19-nor-1,25-(OH) 2-vitamin D 2.Marketed by Abbott Laboratories under the trade name Zemplar) is a drug used for the prevention and treatment of secondary hyperparathyroidism (excessive secretion of parathyroid hormone) associated with chronic kidney failure.
[4]: 100–101, 371–379 [5] [33] The prevalence of vitamin D deficiency increases with age due to a decrease in 7-dehydrocholesterol synthesis in the skin and a decline in kidney capacity to convert calcidiol to calcitriol, [34] the latter seen to a greater degree in people with chronic kidney disease. [35]
The kidneys are responsible for converting 25-hydroxyvitamin D to 1,25-hydroxyvitamin D. This is the active form of vitamin D in the body. Kidney disease reduces 1,25-hydroxyvitamin D formation, leading to a deficiency of the effects of vitamin D. [1]
Alfacalcidol has a weaker impact on calcium metabolism [3] and parathyroid hormone levels [4] than calcitriol; but significant effects on the immune system, including regulatory T cells. [5] It is considered to be a more useful form of vitamin D supplementation, mostly due to its much longer half-life and lower kidney load. [ 6 ]
The severity of chronic kidney disease (CKD) is described by six stages; the most severe three are defined by the MDRD-eGFR value, and first three also depend on whether there is other evidence of kidney disease (e.g., proteinuria): 0) Normal kidney function – GFR above 90 (mL/min)/(1.73 m 2) and no proteinuria
However, excessive ingestion of calcium of more than 10-15 g per day has been reported to cause calcium levels too high for renal calcitriol suppression to control, resulting in net calcium absorption that ultimately causes hypercalcemia. [3] [10] Hypercalcemia affects the kidneys in multiple ways that altogether contributes to hypovolemia.
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