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Alfacalcidol (or 1-hydroxycholecalciferol) is an analogue of vitamin D used for supplementation in humans and as a poultry feed additive. 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 ]
They aim to reduce the classical renal and intestinal effects of calcitriol on calcium and phosphate homeostasis, from its effects on other biologic processes. [5] They target cell proliferation and differentiation, especially in skin, or other effects in the parathyroid gland (secondary hyperparathyroidism) or bone cells. [5]
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]
Renal osteodystrophy is usually diagnosed after treatment for end-stage kidney disease begins; however the CKD-MBD starts early in the course of CKD. [ 1 ] [ 6 ] In advanced stages, blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate , and parathyroid hormone levels.
[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]
calcidiol + 2 reduced adrenodoxin + 2 H + + O 2 ⇌ calcitriol + 2 oxidized adrenodoxin + H 2 O The enzyme is also able to oxidize ercalcidiol (25-OH D2) to ercalcitriol, secalciferol to calcitetrol, and 25-hydroxy-24-oxocalciol to (1S)-1,25-dihydroxy-24-oxocalciol.
Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the renal circulation. It stimulates erythropoiesis (production of red blood cells) in the bone marrow. Calcitriol, the activated form of vitamin D, promotes intestinal absorption of calcium and the renal reabsorption of phosphate.
Calcifediol is the precursor for calcitriol, the active form of vitamin D. [3] [4] It is synthesized in the liver, by hydroxylation of cholecalciferol (vitamin D 3) at the 25-position. [3] This enzymatic 25-hydroxylase reaction is mostly due to the actions of CYP2R1 , present in microsomes , although other enzymes such as mitochondrial CYP27A1 ...
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