Vitamin D and kidney disease.
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.
Al-Badr
Wisam
W
Division of Nephrology, Saint Louis University, St. Louis, Missouri, USA.
Martin
Kevin J
KJ
D002908:Chronic Disease; D004872:Ergocalciferols / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014807:Vitamin D / Q000378:metabolism / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D014815:Vitamins / Q000378:metabolism / Q000627:therapeutic use*
D004872:Ergocalciferols; D014815:Vitamins; D014807:Vitamin D