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Aim: To evaluate the efficacy and safety of alfacalcidol and paracalcitol used to correct impaired phosphorus-calcium metabolism (PCM) in patients with predialysis chronic kidney disease (CKD)., Subjects and Methods: Examinations were made in 128 patients with Stages III-V CKD, including 89 (69.5%) patients with chronic glomerulonephritis, 30 (23.4%) with chronic tubulointerstitial nephritis, and 9 (7.1%) with hypertensive nephrosclerosis. Impaired PCM was detected in 90 (70.3%) of the examined patients. According to the pattern of the previous therapy, all the 90 CKD patients with PCM disorders were divided into 3 groups: 1) 32 patients with Stages IIIB-V CKD who had taken oral alfacalcidol 0.25 microg/day; 2) 28 patients with Stages IIIB-V CKD who had used oral paricalcitol 1 microg/day; 3) 30 patients with Stages IIIB-V CKD who had not received, as self- motivated, active vitamin D metabolites at the predialysis stage., Results: Alfacalcidol and paricalcitol were quite satisfactorily tolerated by the patients. After 3 months of initiation of the use of these agents, Groups 1 and 2 patients with predialysis CKD and baseline elevated blood intact parathyroid hormone (iPTH) levels could not only achieve, but also maintain target blood iPTH levels. In the patients taking paricalcitol, the urinary protein level decreased more promptly; moreover, by the end of month 6 the reduction in blood pressure (BP) was more significant than in those using alfacalcidol (p < 0.05). Comparison of the effects of angiotensin-converting enzyme inhibitors in combination with alfacalcidol or paricalcitol on BP changes and left ventricular mass index indicated that the most pronounced positive changes occurred when angiotensin-converting enzyme inhibitors were used in combination with paricalcitol., Conclusion: The use of paricalcitol in predialysis CKD with PTH hyperproduction results in not only normalization of the levels of both PTH and osseous isoenzyme of alkaline phosphatase, but also in significantly reduced daily proteinuria and regression of left ventricular hypertrophy and chronic heart failure.

Aim: To evaluate antiresorptive properties of alphacalcidol in the treatment of osteopenic syndrome in patients with chronic obstructive pulmonary disease (COPD)., Material and Methods: A total of 94 COPD patients with low densitometric indices were studied for bone densitometric parameters, calcium-phosphorus metabolism, markers of bone tissue metabolism (osteocalcine-OC, tartrate-resistent acid phosphatase--TRAP, beta CrossLaps - BCL), cytokine profile in the course of 6-month continuous therapy with alpha-calcidol (alpha-D3-TEVA) in a dose 0.75-1 mcg/day., Results: Six-month treatment with alpha-calcidol relieved pain, increased bone densitometric parameters, normalized calcium-phosphorus metabolism. While 3-month therapy induced positive dynamics in markers of bone metabolism (OC level increased, concentrations of BCL, TRAP reduced), 6-month therapy resulted in these parameters normalization close to the level of healthy persons. Proinflammatory cytokines (IL-1beta, IL-6 TNF-alpha) in COPD lowered significantly., Conclusion: Alpha-calcidol have analgetic, antiresorptive and immunomodulating effects which make this drug effective in prevention and pathogenetic therapy of osteopenic syndrome in COPD.

The analysis of antiosteoporotic efficacy of alphacalcidol was made in 50 patients with rheumatoid arthritis (RA). 30 RA patients received alphacalcidol in a dose 0.75-1.0 mcg/day for 12 months. 20 control RA patients did not receive the drug. Mineral density of the bone tissue (MD) of the proximal femur and low back spine was studied using double x-ray absorptiometry at the start of the treatment and 12 months after it. It was established that alphacalcidol stabilizes MD of the neck of the femur and low spine. A significant MD increase was observed in those areas of the proximal femur where cortical bone tissue prevails.

Amino acid analysis and investigation of nitrogen, calcium and phosphorus balance were done in two groups of patients with renal failure and osteodystrophy on vitamin D metabolites and analogues treatment. The results of the investigation confirm vitamin D metabolites influence on free amino acid metabolism and on nitrogen, calcium, phosphorus balance. We observed significant decreases of blood amino acids and good influence on renal osteodystrophy in patients treated with vitamin D metabolites. Vitamin D metabolites didn't influence retention, urinary and fecal excretion of endogenous nitrogen in patients with renal failure.

In all the examined children with chronic glomerulonephritis (GN), peripheral blood lymphocytes had a high concentration of receptors of 1,25 (OH)2D3, a hormonal form of vitamin D. At the same time as to the healthy children, 1,25 (OH)2D3 receptors were identified only in 27%, with the concentration being lower. A large amount of 1,25 (OH)2D3 receptors may be related to the expression of the hormone in activated lymphocytes. In addition to the normalization of calcium metabolism, the treatment with oxydevit favoured the normalization of the content of IgG and T lymphocytes as well as a reduction (to normal) of the content of 0 lymphocytes regardless of the previous treatment. Partial remission was attained in 14 out of 20 GN patients. In 10 of these children, the remission lasting 1-2 years was attained for the first time. In 17 children treated with oxydevit, the incidence of acute respiratory viral infection decreased from 6-8 times to 1-2 times a year. The data obtained allowed one to ascertain the immunomodulatory capacities of oxydevit in children with chronic glomerulonephritis.