Vitamin D and kidney disease.

Abstract

Abnormalities in vitamin D metabolism play a major role in the pathogenesis of secondary hyperparathyroidism in chronic kidney disease. The gradual and progressive decline in 1,25-dihydroxyvitamin D in the course of chronic kidney disease is the result of several mechanisms that limit the ability of the failing kidney to maintain the levels of 1,25-dihydroxyvitamin D despite increasing levels of parathyroid hormone. Recent observations have indicated that chronic kidney disease seems to be associated with a high incidence of nutritional vitamin D insufficiency or deficiency as manifested by decreased levels of 25-hydroxyvitamin D. This contributes to the inability to maintain the levels of 1,25-dihydroxyvitamin D; therefore, current practice guidelines suggest repleting vitamin D status by the administration of native vitamin D as a first step in the therapy of the abnormalities of bone and mineral metabolism in chronic kidney disease. The efficacy of this therapy is extremely variable, and active vitamin D sterols may be required, especially as kidney disease progresses. The importance of the abnormal vitamin D metabolism is being investigated vigorously in view of the observations that vitamin D may have important biologic actions in many tissues in addition to bone and parathyroid. Thus, observational data have suggested potential survival benefits of vitamin D sterol administration in this clinical setting, and experimental data have suggested a potential beneficial effect of vitamin D sterols on the progression of kidney disease. Further work is required to define the mechanisms involved and to examine the effects of vitamin D therapy on outcomes in randomized, controlled trials.

• Authors: Wisam Al-Badr, Kevin J Martin
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 3 Issue 5 Pg. 1555-60 (Sep 2008) ISSN: 1555-905X [Electronic] United States
• PMID: 18450926 (Publication Type: Journal Article)

Chemical References

• Ergocalciferols
• Vitamins
• Vitamin D

Topics

• Chronic Disease
• Ergocalciferols (therapeutic use)
• Evidence-Based Medicine
• Humans
• Hyperparathyroidism, Secondary (drug therapy, etiology, metabolism)
• Kidney Diseases (complications, drug therapy, metabolism, mortality)
• Practice Guidelines as Topic
• Treatment Outcome
• Vitamin D (metabolism, therapeutic use)
• Vitamin D Deficiency (complications, drug therapy, metabolism, mortality)
• Vitamins (metabolism, therapeutic use)