title: The immunoregulatory function of vitamin D: implications in chronic kidney disease.
abstract: Cardiovascular and infectious diseases remain the most common causes of death among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Basic science and epidemiological studies indicate that vitamin D has importance not only for cardiovascular health, but also for the immune response. Vitamin D signaling pathways regulate both innate and adaptive immunity, maintaining the associated inflammatory response within physiological limits. Levels of both the inactive as well as active form of vitamin D (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, respectively) are decreased in patients with CKD and ESRD. It is reasonable to hypothesize, therefore, that the immune dysfunction associated with vitamin D deficiency in patients with CKD and ESRD in part explains the misdirected inflammatory response and increased susceptibility to infection seen in this population. Indeed, observational studies show that vitamin D deficiency in patients with ESRD is associated with increased mortality, and treatment with vitamin D is associated with a decreased risk of infection, as well as reduced all-cause mortality. However, whether different vitamin D preparations have differential effects on physiological function and clinical outcomes is still unclear. A proper understanding of the immune regulatory function of vitamin D is important for the development of future therapeutic strategies.
authors.affiliation: Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Sterling
authors.forename: Parham
authors.initials: P
authors.lastname: Eftekhari
authors.forename: Matthias
authors.initials: M
authors.lastname: Girndt
authors.forename: Paul L
authors.initials: PL
authors.lastname: Kimmel
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
mesh_terms: D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000276:immunology* / Q000378:metabolism / Q000401:mortality; D012307:Risk Factors; D015398:Signal Transduction / Q000276:immunology*; D014807:Vitamin D / Q000276:immunology* / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000276:immunology* / Q000378:metabolism / Q000401:mortality
chemical_list: D014807:Vitamin D