Vitamin D und sekundärer Hyperparathyreoidismus (sHPT) bei CKD im Spiegel der Zeit

ZUSAMMENFASSUNG

Ein Vitamin-D-Mangel trägt bei Patienten mit chronischer Nierenerkrankung (CKD: Chronic Kidney Disease) entscheidend zur Entstehung eines sekundären Hyperparathyreoidismus (sHPT) bei. Der Ausgleich dieses Mangels bei CKD-Patienten mit sHPT durch eine regelmäßige Vitamin-D-Substitution hat sich in den letzten Jahrzehnten in Form einer Springprozession vollzogen: Jeder Schritt vor und zurück hat neue, wichtige Erkenntnisse zu den komplexen Zusammenhängen zwischen der medikamentösen Substitution von Vitamin D und den Effekten auf das Parathormon (PTH) und den Knochenstoffwechsel erbracht. Heute können die unerwünschten Nebenwirkungen der Vitamin-D-Therapie (Hyperkalzämie, Hyperphosphatämie) besser kontrolliert werden. Trotzdem steht der Nachweis des klinischen Nutzens immer noch aus, da in den klinischen Studien bisher keine „harten“ Endpunkte (kardiovaskuläre Ereignisse, Frakturen, Mortalität etc.) untersucht worden sind.

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