Vitamin D deficiency and toxicity in chronic kidney disease: in search of the therapeutic window.
Both vitamin D deficiency and vitamin D toxicity are associated with cardiovascular complications in chronic kidney disease (CKD). Clinical and experiment data indicate that the association of vitamin D levels with cardiovascular disease is best illustrated as a biphasic, or U-shaped, curve. Children and adolescents with CKD need vitamin D due to the demands of a growing skeleton, to prevent renal rickets. However, this therapy carries the risk of severe side effects and chronic toxicity. Observational studies show that vitamin D deficiency and toxicity are frequently present in patients with CKD. In view of the importance of cardiovascular complications for the long-term survival of young patients, these findings demand a judicious use of vitamin D preparations. In clinical practice, the therapeutic window is rather small, presenting a therapeutic challenge to avoid both vitamin D deficiency and toxicity.
Querfeld
Uwe
U
Department of Pediatric Nephrology, Charite Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany. uwe.querfeld@charite.de
Mak
Robert H
RH
D000293:Adolescent; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D019587:Dietary Supplements / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D018673:Nutrition Policy; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D014807:Vitamin D / Q000009:adverse effects* / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism
D014807:Vitamin D