nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2012-16-3/1-80-87nefr-598Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSСТАТУС ВИТАМИНА D И ПАТОЛОГИЯ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У ПАЦИЕНТОВ С РАЗЛИЧНЫМИ СТАДИЯМИ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕКVITAMIN D STATE AND CARDIOVASCULAR SYSTEM PATHOLOGY AT PATIENTS WITH DIFFERENT STAGES OF CHRONIC KIDNEY DISEASEРафрафиХ.RafrafiH.

Кафедра пропедевтики внутренних болезней

ВолковМ. М.VolkovM. M.

Кафедра пропедевтики внутренних болезней

197022, Санкт-Петербург, ул. Толстого, д. 17, тел.:8-812-234-01-65

vmm58@mail.ruСмирновА. В.SmirnovA. V.

Кафедра пропедевтики внутренних болезней

ГалкинаО. В.GalkinaO. V.Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияНаучно-исследовательский институт, Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссия201210032012163/18087Copyright © Рафрафи Х., Волков М.М., Смирнов А.В., Галкина О.В., 20122012Рафрафи Х., Волков М.М., Смирнов А.В., Галкина О.В.Rafrafi H., Volkov M.M., Smirnov A.V., Galkina O.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/598

ЦЕЛЬ ИССЛЕДОВАНИЯ. Определение связи статуса витамина D (ВД) с патологией сердечно-сосудистой системы у пациентов с различными стадиями хронической болезни почек (ХБП). ПАЦИЕНТЫ И МЕТОДЫ. Обследованы 102 пациентов с ХБП 1-4 стадии, М/Ж – 49/53, 60,6±12,6 года, в основном с диабетической нефропатией (91,2 %) и 79 пациентов с ХБП 5д стадии, получавших хронический бикарбонатный гемодиализ в среднем 72,0±80,0 мес, М/Ж –36/43, 45,5% – с хроническим гломерулонефритом. Пациентам были выполнены эхокардиография, пределение толщины комплекса интима–медиа сонных артерий (КИМ) и суточное мониторирование ЭКГ и АД. Помимо обычных клинических и биохимических показателей, иммуноферментным методом были определены 25(OH)D и 1,25(OH)2D. РЕЗУЛЬТАТЫ. У пациентов с ХБП 1-4 стадии дефицит 25(OH)D (<30 нмоль/л) был выявлен у 14,9%, недостаточность (30–75 нмоль/л) – у 55,4% и оптимальные значения (>75 нмоль/л) – у 29,7%. У больных с ХБП 5д – недостаточность была определена у 49,4%, дефицит – у 50,6%. В группе с ХБП 1-4 стадии в 63,8% случаев был обнаружен дефицит 1,25(OH)2D (<53 пмоль/л), в группе с ХБП 5д стадии – у всех пациентов. У больных с ХБП 1-4 стадии низкие значения 1,25(OH)2D сыворотки сочетались с более высоким АД (p=0,01), более частыми эпизодами ишемии миокарда по данным суточного мониторирования ЭКГ (p=0,027). Более низкие значения 1,25(OH)2D отмечались у пациентов с ХБП 1-4 стадии при наличии гипертрофии миокарда (р=0034), кальциноза сердечных клапанов (р=0,042). Меньшие значения 25(OH)D сыворотки крови были ассоциированы с клиническими проявлениями сердечной недостаточности (р=0,004), с кальцинозом сердечных клапанов (р=0,021), с большей толщиной КИМ (р=0,005), большей частотой суправентрикулярной экстрасистолии (р=0,016). У пациентов с ХБП 5д стадии при более низком уровне 25(OH)D наблюдалась более частая суправентрикулярная экстрасистолия (Rs=-0,33; p=0,039). ЗАКЛЮЧЕНИЕ. У пациентов с ХБП часто встречается недостаточность и дефицит 25(OH)D и 1,25(OH)2D, особенно при ХБП 5д стадии. Низкие значения 25(OH)D и 1,25(OH)2D ассоциированы с более выраженной АГ, гипертрофией миокарда, атеросклерозом сосудов, кальцинозом сердечных клапанов, суправентрикулярной экстрасистолией, сердечной недостаточностью.

AIM OF RESEARCH. Determination of relation between vitamin D (VD) state and cardiovascular system pathology at patietns with different stages of chronic kidney disease (CKD). PATIENTS AND METHODS. 102 patients with CKD of 1-4 stages were examined, m/f – 49/53, mean age 60,6±12,6 years, commonly with diabetic nephropathy (91,2%) and 79 patients with CKD of 5D stage, receiving chronic bicarbonate hemodialysis average for 70,0±80,0 months, m/f – 36/43, 45,5% - with chronic glomerulonephritis. Patients were performed echocardiography, Carotid intima-media thickness test (CIMT) and ECG and arterial blood pressure 24-hour monitoring. Except usual clinical and biochemical factors 25(OH)D and 1,25(OH)2D were determined by immunoenzyme method. RESULTS. At patients with CKD of 1-4 stages deficiency of 25(OH)D (<30 nM/l) were diagnosed in 14,9%, insufficiency (30-75 nM/l) – in 55,4% and optimal values (>75 nM/l) – in 29,7%. At patients with CKD of 5D stage – insufficiency was determined in 49,4%, deficiency – in 50,6%. In group of patients with CKD of 1-4 stage 1,25(OH)2D deficiency was determined in 63,8 cases (<53 nM/l), in group of patients with CKD of 5D stage – in all patients. At patients with CKD of 1-4 stage low values of 1,25(OH)2D combined with higher arterial blood pressure (p=0,01), more frequent myocardial ischemia episodes according to ECG monitoring data (p=0,027). Lower values of 1,25(OH)2D were observed in patients with CKD of 1-4 stages at myocardium hypertrophy (p=0,034), cardiac valve calcinosis (p=0,042). Lower values of 25(OH)D blood serum were associated with clinical significant of heart failure (p=0,004), cardiac valve calcinosis (p=0,021), with more CIMT (p=0,005), with more frequent supraventricular extrasystole (p=0,016). At patients with CKD of 5D stage at lower level of 25(OH)D more frequent supraventriclular extrasystole was observed (RS=-0,33; p=0,039). CONCLUSION. At patients with CKD insufficiency and deficiency of 25(OH)D and 1,25(OH)2D is frequent, especially at CKD of 5D stage. Lower values of 25(OH)D and 1,25(OH)2D are associated with more significant AH, myocardium hypertrophy, vascular sclerosis, cardiac valve calcinosis, supraventricular extrasystole, heart failure.

витамин D25(OH)D125(OH)2Dхроническая болезнь почекартериальная гипертензиягипертрофия миокардаИБСкальциноз сердечных клапановсуправентрикулярная экстрасистолиясердечная недостаточностьvitamin D25(OH)D125(OH)2Dchronic kidney diseasearterial hypertensionmyocardium hypertrophyIHDcardiac valve calcinosissupraventricular extrasystoleheart failureReferencesCouser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 2011;80(12):1258-1270Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 2011;80(12):1258-1270Владимирова ЮФ. Течение и исходы ишемической болезни сердца у больных, получающих лечение хроническим гемодиализом. Автореферат дис. … канд. мед. Наук. СПб., 2010Владимирова ЮФ. Течение и исходы ишемической болезни сердца у больных, получающих лечение хроническим гемодиализом. Автореферат дис. … канд. мед. Наук. СПб., 2010Marniemi J, Alanen E, Impivaara O et al. Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutr Metab Cardiovasc Dis 2005;15(3):188-197Marniemi J, Alanen E, Impivaara O et al. Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutr Metab Cardiovasc Dis 2005;15(3):188-197Anderson JL, May HT, Horne BD et al. Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 2010;106(7):963-968Anderson JL, May HT, Horne BD et al. Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 2010;106(7):963-968Xing N, L Maldonado ML, Bachman LA et al. Distinctive dendritic cell modulation by vitamin D(3) and glucocorticoid pathways. Biochem Biophys Res Commun 2002;297(3):645-652Xing N, L Maldonado ML, Bachman LA et al. Distinctive dendritic cell modulation by vitamin D(3) and glucocorticoid pathways. Biochem Biophys Res Commun 2002;297(3):645-652Mathieu C, Adorini L. The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents. Trends Mol Med 2002;8(4):174-179Mathieu C, Adorini L. The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents. Trends Mol Med 2002;8(4):174-179Glass CK, Witztum JL. Atherosclerosis: the road ahead. Cell 2001;104(4):503-516Glass CK, Witztum JL. Atherosclerosis: the road ahead. Cell 2001;104(4):503-516Timms PM, Mannan N, Hitman GA et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 2002;95(12):787-796Timms PM, Mannan N, Hitman GA et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 2002;95(12):787-796Смирнов АВ, Волков ММ, Добронравов ВА, Рафрафи Х. Фосфорно-кальциевый обмен и состояние сердечнососудистой системы у пациентов с ранними стадиями хронической болезни почек. Тер архив 2010; 6: 25-28Смирнов АВ, Волков ММ, Добронравов ВА, Рафрафи Х. Фосфорно-кальциевый обмен и состояние сердечнососудистой системы у пациентов с ранними стадиями хронической болезни почек. Тер архив 2010; 6: 25-28Li YC,Kong J, Wei M et al. 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002;110:229–238Li YC,Kong J, Wei M et al. 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002;110:229–238Kristal-Bohen E, Froom P, Harari G et al. Association of calcitriol and blood pressure in normotensive men. Hypertension 1997;30:1289-1294Kristal-Bohen E, Froom P, Harari G et al. Association of calcitriol and blood pressure in normotensive men. Hypertension 1997;30:1289-1294Lind L, Hanni A, Lithell H et al. Vitamin D is related to blood pressure and other cardiovascular risk factors in middle-aged men. Am J Hypertens 1995;8(9):894-901Lind L, Hanni A, Lithell H et al. Vitamin D is related to blood pressure and other cardiovascular risk factors in middle-aged men. Am J Hypertens 1995;8(9):894-901Боровская ЕВ. Артериальное давление у больных с хронической болезнью почек v стадии, получающих лечение гемодиализом: уровень, динамика и суточный профиль: Автореф. дис. … канд. мед. Наук. СПб., 2010.Боровская ЕВ. Артериальное давление у больных с хронической болезнью почек v стадии, получающих лечение гемодиализом: уровень, динамика и суточный профиль: Автореф. дис. … канд. мед. Наук. СПб., 2010.Weishaar RE, Simpson RU. The involvement of the endocrine system in regulating cardiovascular function: emphasis on vitamin D3. Endocr Rev 1989;10(3):351-365Weishaar RE, Simpson RU. The involvement of the endocrine system in regulating cardiovascular function: emphasis on vitamin D3. Endocr Rev 1989;10(3):351-365Bodyak N, Ayus JC, Achinger S et al. Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals. Proc Natl Acad Sci U S A 2007;104(43):16810-16815Bodyak N, Ayus JC, Achinger S et al. Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals. Proc Natl Acad Sci U S A 2007;104(43):16810-16815Mancuso P, Rahman A, Hershey SD et al. 1,25-Dihydroxyvitamin-D3 treatment reduces cardiac hypertrophy and left ventricular diameter in spontaneously hypertensive heart failure-prone (cp/+) rats independent of changes in serum leptin. J Cardiovasc Pharmacol 2008;51(6):559-564Mancuso P, Rahman A, Hershey SD et al. 1,25-Dihydroxyvitamin-D3 treatment reduces cardiac hypertrophy and left ventricular diameter in spontaneously hypertensive heart failure-prone (cp/+) rats independent of changes in serum leptin. J Cardiovasc Pharmacol 2008;51(6):559-564Zittermann A, Schleithoff SS, Tenderich G et al. Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 2003;41(1):105-112Zittermann A, Schleithoff SS, Tenderich G et al. Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 2003;41(1):105-112García-Canton C, Bosch E, Ramírez A et al. Vascular calcification and 25-hydroxyvitamin D levels in non-dialysis patients with chronic kidney disease stages 4 and 5. Nephrol Dial Transplant 2011;26(7):2250-2256García-Canton C, Bosch E, Ramírez A et al. Vascular calcification and 25-hydroxyvitamin D levels in non-dialysis patients with chronic kidney disease stages 4 and 5. Nephrol Dial Transplant 2011;26(7):2250-2256Волков ММ, Гордеева ЛА, Смирнов АВ. Кальциноз брюшной аорты у пациентов с хронической болезнью почек. Нефрология 2009; 13 (3): 39-41Волков ММ, Гордеева ЛА, Смирнов АВ. Кальциноз брюшной аорты у пациентов с хронической болезнью почек. Нефрология 2009; 13 (3): 39-41Park CW, Oh YS, Shin YS et al. Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis 1999;33(1):73- 81Park CW, Oh YS, Shin YS et al. Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis 1999;33(1):73- 81Bucharles S, Barberato SH, Stinghen AE et al. Impact of cholecalciferol treatment on biomarkers of inflammation and myocardial structure in hemodialysis patients without hyperparathyroidism. Nephron Clin Pract 2011;118(4):384-391Bucharles S, Barberato SH, Stinghen AE et al. Impact of cholecalciferol treatment on biomarkers of inflammation and myocardial structure in hemodialysis patients without hyperparathyroidism. Nephron Clin Pract 2011;118(4):384-391Zadshir A, Tareen N, Pan D et al. The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis 2005;15(4 Suppl 5):S5-97-101Zadshir A, Tareen N, Pan D et al. The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis 2005;15(4 Suppl 5):S5-97-101Rodríguez Villarreal I, Ortega O, Gallar P et al. [Clinical and biochemical characteristics of predialysis patients in terms of 25 hydroxy vitamin D levels]. Nefrologia 2011;31(2):185-191Rodríguez Villarreal I, Ortega O, Gallar P et al. [Clinical and biochemical characteristics of predialysis patients in terms of 25 hydroxy vitamin D levels]. Nefrologia 2011;31(2):185-191González EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004;24(5):503-510González EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol 2004;24(5):503-510Tolouian R, Rao DS, Goggins M et al. Seasonal variation of vitamin D in patients on hemodialysis. Clin Nephrol 2010;74(1):19- 24Tolouian R, Rao DS, Goggins M et al. Seasonal variation of vitamin D in patients on hemodialysis. Clin Nephrol 2010;74(1):19- 24Jean G, Charra B, Chazot C. Vitamin D deficiency and associated factors in hemodialysis patients. J Ren Nutr 2008;18(5):395-399Jean G, Charra B, Chazot C. Vitamin D deficiency and associated factors in hemodialysis patients. J Ren Nutr 2008;18(5):395-399Del Valle E, Negri AL, Aguirre C et al. Prevalence of 25(OH) vitamin D insufficiency and deficiency in chronic kidney disease stage 5 patients on hemodialysis. Hemodial Int 2007;11(3):315-321Del Valle E, Negri AL, Aguirre C et al. Prevalence of 25(OH) vitamin D insufficiency and deficiency in chronic kidney disease stage 5 patients on hemodialysis. Hemodial Int 2007;11(3):315-321Levin A, Bakris GL, Molitch M et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease . Kidney Int 2007;71:31-3Levin A, Bakris GL, Molitch M et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease . Kidney Int 2007;71:31-3Freundlich M, Quiroz Y, Zhang Z et al. Suppression of renin-angiotensin gene expression in the kidney by paricalcitol. Kidney Int 2008;74(11):1394-402Freundlich M, Quiroz Y, Zhang Z et al. Suppression of renin-angiotensin gene expression in the kidney by paricalcitol. Kidney Int 2008;74(11):1394-402Weishaar RE, Kim SN, Saunders DE, Simpson RU. Involvement of vitamin D3 with cardiovascular function. III. Effects on physical and morphological properties. Am J Physiol 1990;258(1 Pt 1):E134-142Weishaar RE, Kim SN, Saunders DE, Simpson RU. Involvement of vitamin D3 with cardiovascular function. III. Effects on physical and morphological properties. Am J Physiol 1990;258(1 Pt 1):E134-142Xiang W, Kong J, Chen S et al. Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin-angiotensin systems. Am J Physiol Endocrinol Metab 2005;288(1):E125-132Xiang W, Kong J, Chen S et al. Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin-angiotensin systems. Am J Physiol Endocrinol Metab 2005;288(1):E125-132O'Connell TD, Berry JE, Jarvis AK et al. 1,25-Dihydroxyvitamin D3 regulation of cardiac myocyte proliferation and hypertrophy. Am J Physiol 1997;272(4 Pt 2):H1751-H1758O'Connell TD, Berry JE, Jarvis AK et al. 1,25-Dihydroxyvitamin D3 regulation of cardiac myocyte proliferation and hypertrophy. Am J Physiol 1997;272(4 Pt 2):H1751-H1758Raizada V, Hillerson D, Amaram JS, Skipper B. Angiotensin II-Mediated Left Ventricular Abnormalities in Chronic Kidney Disease. J Investig Med 2012;60(5):785-791Raizada V, Hillerson D, Amaram JS, Skipper B. Angiotensin II-Mediated Left Ventricular Abnormalities in Chronic Kidney Disease. J Investig Med 2012;60(5):785-791O‘Connell TD, Giacherio DA, Jarvis AK, Simpson RU. Inhibition of cardiac myocyte maturation by 1,25-dihydroxyvitamin D3. Endocrinology 1995;136(2):482-488.O‘Connell TD, Giacherio DA, Jarvis AK, Simpson RU. Inhibition of cardiac myocyte maturation by 1,25-dihydroxyvitamin D3. Endocrinology 1995;136(2):482-488.Wu J, Garami M, Cheng T, Gardner DG. 1,25(OH)2 vitamin D3, and retinoic acid antagonize endothelin-stimulated hypertrophy of neonatal rat cardiac myocytes. J Clin Invest 1996; 97(7):1577-1588Wu J, Garami M, Cheng T, Gardner DG. 1,25(OH)2 vitamin D3, and retinoic acid antagonize endothelin-stimulated hypertrophy of neonatal rat cardiac myocytes. J Clin Invest 1996; 97(7):1577-1588Przybylski R, McCune S, Hollis B, Simpson RU. Vitamin D deficiency in the spontaneously hypertensive heart failure [SHHF] prone rat. Nutr Metab Cardiovasc Dis 2010;20(9):641-646Przybylski R, McCune S, Hollis B, Simpson RU. Vitamin D deficiency in the spontaneously hypertensive heart failure [SHHF] prone rat. Nutr Metab Cardiovasc Dis 2010;20(9):641-646Green JJ, Robinson DA, Wilson GE et al. Calcitriol modulation of cardiac contractile performance via protein kinase C. J Mol Cell Cardiol 2006;41(2):350-359Green JJ, Robinson DA, Wilson GE et al. Calcitriol modulation of cardiac contractile performance via protein kinase C. J Mol Cell Cardiol 2006;41(2):350-359Cioffi G, Gatti D, Adami S. Vitamin D deficiency, left ventricular dysfunction and heart failure. G Ital Cardiol (Rome) 2010;11(9):645-653Cioffi G, Gatti D, Adami S. Vitamin D deficiency, left ventricular dysfunction and heart failure. G Ital Cardiol (Rome) 2010;11(9):645-653Milovanovic M, Pesic G, Nikolic V et al. Vitamin d deficiency is associated with increased IL-17 and TNFα levels in patients with chronic heart failure. Arq Bras Cardiol 2012;98(3):259-265Milovanovic M, Pesic G, Nikolic V et al. Vitamin d deficiency is associated with increased IL-17 and TNFα levels in patients with chronic heart failure. Arq Bras Cardiol 2012;98(3):259-265Rienstra M, Cheng S, Larson MG et al. Vitamin D status is not related to development of atrial fibrillation in the community. Am Heart J 2011;162(3):538-541Rienstra M, Cheng S, Larson MG et al. Vitamin D status is not related to development of atrial fibrillation in the community. Am Heart J 2011;162(3):538-541Targher G, Bertolini L, Padovani R et al. Serum 25-hydroxyvitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients. Clin Endocrinol (Oxf) 2006; 65(5):593-597Targher G, Bertolini L, Padovani R et al. Serum 25-hydroxyvitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients. Clin Endocrinol (Oxf) 2006; 65(5):593-597Choi AI, Lo JC, Mulligan K et al. Association of vitamin D insufficiency with carotid intima-media thickness in HIV-infected persons. Clin Infect Dis 2011;52(7):941-944Choi AI, Lo JC, Mulligan K et al. Association of vitamin D insufficiency with carotid intima-media thickness in HIV-infected persons. Clin Infect Dis 2011;52(7):941-944Волков ММ, Дегтерева ОА, Смирнов АВ, Шевякова ЕВ, Панина ИЮ, Трофименко ИИ. Атеросклероз как основной фактор кальциноза клапанного аппарата сердца в додиализном периоде хронической болезни почек. Нефрология 2007; 11(4): 47-54Волков ММ, Дегтерева ОА, Смирнов АВ, Шевякова ЕВ, Панина ИЮ, Трофименко ИИ. Атеросклероз как основной фактор кальциноза клапанного аппарата сердца в додиализном периоде хронической болезни почек. Нефрология 2007; 11(4): 47-54Волков ММ, Смирнов АВ, Добронравов ВА, Дегтерева ОА, Шевякова ЕВ, Панина ИЮ, Трофименко ИИ. Кальциноз сердечных клапанов у пациентов с хронической болезнью почек: связь с клинико-биохимическими показателями и влияние на внутрисердечную гемодинамику. Клин мед 2009; 87(6): 31-35Волков ММ, Смирнов АВ, Добронравов ВА, Дегтерева ОА, Шевякова ЕВ, Панина ИЮ, Трофименко ИИ. Кальциноз сердечных клапанов у пациентов с хронической болезнью почек: связь с клинико-биохимическими показателями и влияние на внутрисердечную гемодинамику. Клин мед 2009; 87(6): 31-35Волков ММ, Галкина ОВ, Бурдаева ЯВ, Жлоба АА, Эмануэль ВЛ. Значимость определения 25(OH)- и 1,25(OH)2- витамина D у пациентов с хронической болезнью почек в додиализном периоде. Ученые записки СПбГМУ им. акад. И.П.Павлова 2008 XV (1) 41-45Волков ММ, Галкина ОВ, Бурдаева ЯВ, Жлоба АА, Эмануэль ВЛ. Значимость определения 25(OH)- и 1,25(OH)2- витамина D у пациентов с хронической болезнью почек в додиализном периоде. Ученые записки СПбГМУ им. акад. И.П.Павлова 2008 XV (1) 41-45Смирнов АВ, Волков ММ, Добронравов ВА. Кардиопротективные эффекты D-гормона: обзор литературы и собственные данные. Нефрология 2009; 13(1):30-38Смирнов АВ, Волков ММ, Добронравов ВА. Кардиопротективные эффекты D-гормона: обзор литературы и собственные данные. Нефрология 2009; 13(1):30-38Shroff R, Egerton M, Bridel M et al. A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol 2008;19(6):1239-1246Shroff R, Egerton M, Bridel M et al. A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol 2008;19(6):1239-1246Zittermann A, Schleithoff SS, Koerfer R. Vitamin D and vascular calcification. Curr Opin Lipidol 2007;18(1):41-46Zittermann A, Schleithoff SS, Koerfer R. Vitamin D and vascular calcification. Curr Opin Lipidol 2007;18(1):41-46Razzaque MS. The dualistic role of vitamin D in vascular calcifications. Kidney Int 2011;79(7):708-714Razzaque MS. The dualistic role of vitamin D in vascular calcifications. Kidney Int 2011;79(7):708-714Aoshima Y, Mizobuchi M, Ogata H et al. Vitamin D receptor activators inhibit vascular smooth muscle cell mineralization induced by phosphate and TNF-α. Nephrol Dial Transplant 2012; 27(5):1800-1806Aoshima Y, Mizobuchi M, Ogata H et al. Vitamin D receptor activators inhibit vascular smooth muscle cell mineralization induced by phosphate and TNF-α. Nephrol Dial Transplant 2012; 27(5):1800-1806Rebsamen MC, Sun J, Norman AW, Liao JK. 1alpha,25- dihydroxyvitamin D3 induces vascular smooth muscle cell migration via activation of phosphatidylinositol 3-kinase. Circ Res 2002;91(1):17-24Rebsamen MC, Sun J, Norman AW, Liao JK. 1alpha,25- dihydroxyvitamin D3 induces vascular smooth muscle cell migration via activation of phosphatidylinositol 3-kinase. Circ Res 2002;91(1):17-24Cardus A, Parisi E, Gallego C et al. 1,25-Dihydroxyvitamin D3 stimulates vascular smooth muscle cell proliferation through a VEGF-mediated pathway. Kidney Int 2006;69(8):1377-1384Cardus A, Parisi E, Gallego C et al. 1,25-Dihydroxyvitamin D3 stimulates vascular smooth muscle cell proliferation through a VEGF-mediated pathway. Kidney Int 2006;69(8):1377-1384Yamamoto T, Kozawa O, Tanabe K et al. 1,25-dihydroxyvitamin D3 stimulates vascular endothelial growth factor release in aortic smooth muscle cells: role of p38 mitogen-activated protein kinase. Arch Biochem Biophys 2002;398(1):1-6Yamamoto T, Kozawa O, Tanabe K et al. 1,25-dihydroxyvitamin D3 stimulates vascular endothelial growth factor release in aortic smooth muscle cells: role of p38 mitogen-activated protein kinase. Arch Biochem Biophys 2002;398(1):1-6Cardus A, Panizo S, Parisi E et al. Differential effects of vitamin D analogs on vascular calcification. J Bone Miner Res 2007; 22(6):860-866Cardus A, Panizo S, Parisi E et al. Differential effects of vitamin D analogs on vascular calcification. J Bone Miner Res 2007; 22(6):860-866Thomas GN, O Hartaigh B, Bosch JA et al. Vitamin D levels predict all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Diabetes Care 2012; 35(5):1158-1164Thomas GN, O Hartaigh B, Bosch JA et al. Vitamin D levels predict all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Diabetes Care 2012; 35(5):1158-1164Schöttker B, Ball D, Gellert C, Brenner H. Serum 25-hydroxyvitamin D levels and overall mortality. A systematic review and meta-analysis of prospective cohort studies. Ageing Res Rev 2012 Feb 17 [Epub ahead of print]Schöttker B, Ball D, Gellert C, Brenner H. Serum 25-hydroxyvitamin D levels and overall mortality. A systematic review and meta-analysis of prospective cohort studies. Ageing Res Rev 2012 Feb 17 [Epub ahead of print]Pilz S, Iodice S, Zittermann A et al. Vitamin D status and mortality risk in CKD: a meta-analysis of prospective studies. Am J Kidney Dis 2011;58(3):374-382Pilz S, Iodice S, Zittermann A et al. Vitamin D status and mortality risk in CKD: a meta-analysis of prospective studies. Am J Kidney Dis 2011;58(3):374-382Santoro D, Gitto L, Ferraro A et al. Vitamin D status and mortality risk in patients with chronic kidney disease. Ren Fail 2011; 33(2):184-191Santoro D, Gitto L, Ferraro A et al. Vitamin D status and mortality risk in patients with chronic kidney disease. Ren Fail 2011; 33(2):184-191Ravani P, Malberti F, Tripepi G et al. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int 2009;75(1):88-95Ravani P, Malberti F, Tripepi G et al. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int 2009;75(1):88-95Krause R, Schober-Halstenberg HJ, Edenharter G et al. Vitamin D status and mortality of German hemodialysis patients. Anticancer Res 2012; 32(1):391-395Krause R, Schober-Halstenberg HJ, Edenharter G et al. Vitamin D status and mortality of German hemodialysis patients. Anticancer Res 2012; 32(1):391-395Fiedler R, Dorligjav O, Seibert E et al. Vitamin D Deficiency, Mortality, and Hospitalization in Hemodialysis Patients with or without Protein-Energy Wasting. Nephron Clin Pract 2011;119(3): 220-226Fiedler R, Dorligjav O, Seibert E et al. Vitamin D Deficiency, Mortality, and Hospitalization in Hemodialysis Patients with or without Protein-Energy Wasting. Nephron Clin Pract 2011;119(3): 220-226Kovesdy CP, Ahmadzadeh S, Anderson JE, Kalantar-Zadeh K. Association of activated vitamin D treatment and mortality in chronic kidney disease. Arch Intern Med 2008;168(4):397- 403Kovesdy CP, Ahmadzadeh S, Anderson JE, Kalantar-Zadeh K. Association of activated vitamin D treatment and mortality in chronic kidney disease. Arch Intern Med 2008;168(4):397- 403Teng M, Wolf M, Ofsthun MN et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol 2005;16(4):1115-1125Teng M, Wolf M, Ofsthun MN et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol 2005;16(4):1115-1125

The authors declare that there are no conflicts of interest present.