Role of vitamin D receptor activators on cardiovascular risk

Cardiovascular complications are the main cause of death in patients with chronic renal disease. In those patients, vascular calcifications and left ventricular hypertrophy (LVH) are common findings that increase the incidence of cardiac-related deaths. The cardiovascular risk factors associated with renal patients are specific for this population, with hyperphosphatemia among the most common findings. Hyperphosphatemia per se is able to increase vascular calcification with the subsequent decrease in vascular compliance and related disorders. Thus, a strict control of serum phosphate is recommended in renal patients. Recent experimental results have shown that active vitamin D compounds can reduce LVH by direct effects in the myocardium. However, some of these compounds show as a secondary unwanted effect and increase in serum phosphorus. New available vitamin D receptor activators with lower effect in serum phosphorus are available. Thus, a severe control of serum phosphorus plus administration of active vitamin D compounds with no hyperphosphatemic effects could be a very effective treatment against cardiovascular complications in chronic kidney disease patients.