Factores no tradicionales de riesgo vascular en pacientes en hemodiálisismetabolismo mineral, inflamación y oxidación

Abstract

Patients with chronic kidney disease (CKD) are subject to a number of risk factors common to the general population, the so-called traditional risk factors, involving an increase in morbidity, at the expense mainly of an increase in cardiovascular disease. The ERC per se, power itself this risk. So added, such patients are also exposed to so-called non-traditional risk factors, which lead to renal patient to a perpetual state of inflammation and oxidation, which greatly increases morbidity said. Some of these factors are endothelial dysfunction, anemia, hyperphosphatemia, changes in mineral metabolism, circadian rhythm disturbances and oxidative stress among others. Within these factors include changes that occur in the metabolism of calcium and secondary hyperparathyroidism, to cause biochemical changes leading to skeletal and themselves to increased oxidation and inflammation in these renal patients. There are many treatments used to alleviate these conditions. It is at this point where this thesis focuses. The objectives are based on determining the influence of different treatments as calcimimetics, paricalcitol and vitamin D are active and inactive on mineral control metabolism and other markers of inflammation and oxidation in patients undergoing hemodialysis, and the benefit derived from treatment on non-traditional risk factors in these patients. As shown in the first study presented in this thesis (De Francisco AL, Left M et al. Nephrol Dial Transplant 2008), treatment with cinacalcet down ionized calcium levels and serum PTH independently of extracellular calcium concentration ( calcium concentration in the dialysis liquid). Cinacalcet as through changes in calcium receptor, it becomes more sensitive at lower calcium concentrations in extracellular fluid and therefore decreases serum PTH levels, to separate calcium levels manner, thus showing these patients a shift of the Ca2 + -PTH curve to the left. Treatment with intravenous paricalcitol appears to decrease some markers of inflammation and oxidation as well as other anti-inflammatories and antioxidants increase in the sample of patients treated hemodialysis (Left MJ et al. Nephrology 2012). In the third paper (Piñera C, Left MJ et al. Nefrologia 2013) shown as combined therapy of oral paricalcitol (vitamin D active) with oral calcifediol (vitamin D inactive), descends PTH levels significantly increasing levels serum calcium. In light of the results obtained in the sample of treated patients, the association of both treatments appears to have no benefit over monotherapy with each of them. Paricalcitol alone if it seems to have a direct effect on bone remodeling. We conclude therefore that both calcimimetics as derivatives of vitamin D, active and non-active influence the correction of non-traditional risk factors observed in chronic kidney disease patients on hemodialysis.