Información de la revista
Vol. 33. Núm. 5.Septiembre 2013
Páginas 623-868
Vol. 33. Núm. 5.Septiembre 2013
Páginas 623-868
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Paricalcitol oral como agente antiproteinúrico en la enfermedad renal crónica
Oral paricalcitol as antiproteinuric agent in chronic kidney disease
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Alberto de Lorenzoa, Alberto de Lorenzob, Laura Salanovaa, Laura Salanovab, Andrew S. Bombackc, Andrew S. Bombackd, María Moyaa, Maria Moyab, Francisco Coronele, Carmen Bernisa, Carmen Bernisb, José A. Sánchez-Tomeroa, José Antonio Sánchez-Tomerob, Vicente Álvareza, Vicente Álvarezb
a Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain,
b Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Madrid, España,
c Division of Nephrology, Columbia University College of Physicians and Surgeons, Presbyterian Hospital, New York, USA,
d Division of Nephrology, Columbia University College of Physicians and Surgeons, Presbyterian Hospital, New York, New York, USA,
e Servicio de Nefrología, Hospital Clinico Universitario San Carlos, Madrid, Madrid, España,
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Introducción: La vitamina D posee un efecto regulatorio del eje renina-angiotensina-aldosterona, jugando, por lo tanto, un papel importante en cuanto a proteinuria se refiere. Presentamos nuestra experiencia en el uso de paricalcitol como antiproteinúrico. Métodos: Incluimos 36 pacientes con un eGFR of 30-90 ml/min/1,73 m2 y proteinuria > 400 mg/d con dosis estables de inhibidores del SRAA durante 3 meses. Se le admistró durante 12 meses 1 µg/día de paricalcitol. Como objetivo primario estudiamos el descenso de proteinuria; como secundarios cambios en Cr, eFG, calcio, fósforo, iPTH, 25(OH)vitD, PCR y tension arterial. Resultados: La proteinuria media fue 2806 mg/d cayendo  hasta 2199 mg/d en el mes 6 (p < 0,0001) y 1931,5 mg/d a los 12 meses (p < 0,0001). Aquellos con una proteinuria basal  > 3000 mg/d (n=12) sufrieron una menor disminución (5956,9 ± 2492,6 mg/d a 4220,4 ± 2613 mg/d en mes 12) respecto a aquellos con una proteinuria < 3000 mg/d (1371 ± 627,5 mg/d a 821,3 ± 491,5 mg/d en mes 12). No se objetivaron cambios en tension arterial, eGFR y PCR. Los cambios en calcio, fósforo, iPTH y vitamina D 25(OH) fueron estadísticamente significativos. Conclusión: Nuestro estudio demuestra una reducción importante de proteinuria con dosis bajas de paricalcitol en pacientes con IRC, que es de particular importancia en aquellos con porteinuria basal entre 1-3 g/d.

Palabras clave:
Proteinuria
Palabras clave:
Sistema renina-angiotensina-aldosterona
Palabras clave:
Paricalcitol
Palabras clave:
Enfermedad renal crónica
Palabras clave:
Vitamina D

Background: Vitamin D has an important regulatory effect on the renin-angiotensin-aldosterone system, playing a central role in the regulation of proteinuria. We therefore studied the antiproteinuric effect of paricalcitol. Methods: 36 patients with an estimated GFR of 30-90mL/min/1.73m2 and proteinuria >400mg/d with a stable dose of ACE inhibitor or ARB for at least 3 months were recruited. Patients received oral paricalcitol 1µg/day for 12 months. Primary endpoint was decrease in proteinuria from baseline. Secondary endpoints were changes in creatinine, eGFR, serum levels of calcium, phosphorus, iPTH, 25(OH)vitD, C-Reactive Protein and blood presure. Results: Mean proteinuria was 2806mg/d and fell to 2199mg/d at month 6 (p<.0001) and 1931.5mg/d at month 12 (p<.0001). Patients with >3000mg/d baseline proteinuria (n=12) saw smaller relative reductions in proteinuria (5956.9±2492.6mg/d to 4220.4±2613mg/d at 12 months) than patients with <3000mg/d baseline proteinuria (1371±627.5 mg/d to 821.3±491.5mg/d at 12 months). There were no changes in BP, eGFR and CRP. We observed significant changes in serum levels of calcium, phosphorus, iPTH, 25(OH) vitamin D. Conclusion: Our study shows an important reduction in proteinuria with a low dose of oral paricalcitol in CKD, that is particularly robust with baseline proteinuria between 1-3g/d.

Keywords:
Proteinuria
Keywords:
Renin-angiotensin system
Keywords:
Paricalcitol
Keywords:
Chronic kidney disease
Keywords:
Vitamin D
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Bibliografía
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