Значение уровня витамина D в развитии и прогрессировании заболеваний почек: современное состояние проблемы

Захарова И.Н., Касьянова А.Н., Климов Л.Я., Долбня С.В., Карайкозова А.А., Минасян А.К., Федько Н.А., Зарытовская Н.В., Попова Е.В. Значение уровня витамина D в развитии и прогрессировании заболеваний почек: современное состояние проблемы. Педиатрия. Consilium Medicum. 2025;1:44–50. DOI: 10.26442/26586630.2025.1.203084

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Zakharova IN, Kasyanova AN, Klimov LYa, Dolbnya SV, Karaikozova AA, Minasyan AK, Fedko NA, Zaritovskaya NV, Popova EV. The role of vitamin D levels in the development and progression of kidney disease: The current state of the problem. A review. Pediatrics. Consilium Medicum. 2025;1:44–50. DOI: 10.26442/26586630.2025.1.203084

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Аннотация

Прогрессирующая потеря функции почек связана со значительной заболеваемостью и смертностью и является важной глобальной проблемой здравоохранения, учитывая высокую распространенность хронической болезни почек (ХБП). В последнее время возникает повышенный интерес к поиску новых терапевтических стратегий, которые могут замедлить прогрессирование снижения функции почек. По данным многочисленных исследований с использованием различных экспериментальных моделей доказано, что лечение активными метаболитами витамина D способно оказывать ренопротекторное действие, пред- отвращая фиброз, апоптоз и воспаление. Кроме того, дефицит и недостаточность витамина D являются распространенными состояниями у пациентов с ХБП, находящихся на преддиализных стадиях. Установлено, что уровень витамина D в сыворотке крови прямо пропорционален функции почек. Недавние клиничес- кие исследования показали, что снижение уровня протеинурии и смертности у пациентов с ХБП, получающих активный витамин D, выходит за рамки классической роли витамина D в поддержании костного и минерального обмена. Следовательно, аналоги витамина D потенциально могут стать компонентами лечения ХБП для достижения лучших клинических результатов у пациентов с прогрессирующими заболеваниями почек и тех, кто находится на гемодиализе. Современные рекомендации рекомендуют лечение витамином D только у пациентов с ХБП средней степени тяжести, сопровождающейся вторичным гиперпаратиреозом и недостаточностью витамина D. В данном обзоре представлены результаты многочисленных исследований, демонстрирующих распространенность дефицита витамина D среди пациентов с различными заболеваниями почек, эффект витамина D в снижении скорости прогрессирования ХБП, а также клинические результаты использования витамина D у пациентов с инфекционными и неинфекционными заболеваниями почек.

Ключевые слова: витамин D, почки, метаболизм витамина D, ренопротективный эффект, антифибротический эффект, противовоспалительный эффект, дефицит витамина D, хроническая болезнь почек, инфекция мочевыводящих путей

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Progressive loss of kidney function is associated with significant morbidity and mortality and is an important global health concern, given the high prevalence of chronic kidney disease (CKD). Recently, there has been an increased interest in finding new therapeutic strategies that may slow the progression of renal dysfunction. Numerous studies using various experimental models have proven that treatment with active metabolites of vitamin D can have a renoprotective effect, preventing fibrosis, apoptosis, and inflammation. In addition, vitamin D deficiency and insufficiency are common conditions in CKD patients in the pre-dialysis stages. It has been established that the vitamin D serum level is directly proportional to kidney function. Recent clinical studies have shown that reducing proteinuria and mortality in CKD patients receiving active vitamin D goes beyond the classical role of vitamin D in maintaining bone and mineral metabolism. Therefore, vitamin D analogs have the potential to become components of CKD treatment to achieve better clinical outcomes in patients with advanced kidney disease and those on hemodialysis. Current guidelines recommend treatment with vitamin D only in patients with moderate CKD with secondary hyperparathyroidism and vitamin D deficiency. This review presents the results of numerous studies demonstrating the prevalence of vitamin D deficiency among patients with various kidney diseases, the effect of vitamin D in reducing the rate of CKD progression, as well as the clinical outcomes of vitamin D use in patients with infectious and non-infectious kidney diseases.

Keywords: vitamin D, kidneys, vitamin D metabolism, renoprotective effect, antifibrotic effect, anti-inflammatory effect, vitamin D deficiency, chronic kidney disease, urinary tract infection

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13. Wimalawansa SJ. Vitamin D Deficiency: effects on oxidative stress, epigenetics, gene regulation, and aging. Biology. 2019;8(2):30. DOI:10.3390/biology8020030
14. Souza CS, Deluque AL, Oliveira BM, et al. Vitamin D deficiency contributes to the diabetic kidney disease progression via increase ZEB1/ZEB2 expressions. Nutr Diabetes. 2023;13(1):9. DOI:10.1038/s41387-023-00238-2
15. Wu W, Li X, Di J, et al. Dietary inflammatory index is associated with vitamin D in CKD patients. Int Urol Nephrol. 2024;56:335-44. DOI:10.1007/s11255-023-03679-x
16. Hilpert J, Wogensen L, Thykjaer T, et al. Expression prof iling conf irms the role of endocytic receptor megalin in renal vitamin D3 metabolism. Kidney Int. 2002;62(5):1672-81. DOI:10.1046/j.1523-1755.2002.00634.x
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Авторы

И.Н. Захарова¹, А.Н. Касьянова*^2,3, Л.Я. Климов², С.В. Долбня^2,3, А.А. Карайкозова², А.К. Минасян², Н.А. Федько², Н.В. Зарытовская², Е.В. Попова²

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
²ФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава России, Ставрополь, Россия;
³ГБУЗ СК «Краевая детская клиническая больница», Ставрополь, Россия
*a.nicolaevnakasjanova@yandex.ru

________________________________________________

Irina N. Zakharova¹, Anna N. Kasyanova*^2,3, Leonid Ya. Klimov², Svetlana V. Dolbnya^2,3, Alena A. Karaikozova², Artem K. Minasyan², Natalya A. Fedko², Natalia V. Zaritovskaya², Elena V. Popova²

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
²Stavropol State Medical University, Stavropol, Russia;
³Regional Children's Clinical Hospital, Stavropol, Russia
*a.nicolaevnakasjanova@yandex.ru

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