title: Pleiotropic effects of vitamin D in chronic kidney disease.
abstract: Low 25(OH)D levels are common in chronic kidney disease (CKD) patients and are implicated in all-cause mortality and morbidity risks. Furthermore, the progression of CKD is accompanied by a gradual decline in 25(OH)D production. Vitamin D deficiency in CKD causes skeletal disorders, such as osteoblast or osteoclast cell defects, bone turnover imbalance, and deterioration of bone quality, and nonskeletal disorders, such as metabolic syndrome, hypertension, immune dysfunction, hyperlipidemia, diabetes, and anemia. Extra-renal organs possess the enzymatic machinery for converting 25(OH)D to 1,25(OH)2D, which may play considerable biological roles beyond the traditional roles of vitamin D. Pharmacological 1,25(OH)2D dose causes hypercalcemia and hyperphosphatemia as well as adynamic bone disorder, which intensifies vascular calcification. Conversely, native vitamin D supplementation reduces the risk of hypercalcemia and hyperphosphatemia, which may play a role in managing bone and cardio-renal health and ultimately reducing mortality in CKD patients. Nevertheless, the combination of native vitamin D and active vitamin D can enhance therapy benefits of secondary hyperparathyroidism because of extra-renal 1α-hydroxylase activity in parathyroid gland. This article emphasizes the role of native vitamin D replacements in CKD, reviews vitamin D biology, and summarizes the present literature regarding native vitamin D replacement in the CKD population.
authors.affiliation: Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Liu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chia-Chao
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Yao-Min
authors.initials: YM
authors.lastname: Hung
authors.affiliation: Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Pediatrics, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Min-Tser
authors.initials: MT
authors.lastname: Liao
authors.affiliation: Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jia-Fwu
authors.initials: JF
authors.lastname: Shyu
authors.affiliation: Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Yuh-Feng
authors.initials: YF
authors.lastname: Lin
authors.affiliation: Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. Electronic address: kuochenglu@gmail.com.
authors.forename: Kuo-Cheng
authors.initials: KC
authors.lastname: Lu
authors.affiliation: Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan. Electronic address: yen9905@yahoo.com.
authors.forename: Kun-Chieh
authors.initials: KC
authors.lastname: Yeh
mesh_terms: D000818:Animals; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000378:metabolism*; D012306:Risk; D014807:Vitamin D / Q000009:adverse effects / Q000378:metabolism* / Q000494:pharmacology
chemical_list: D014807:Vitamin D
keywords: Chronic kidney disease; Combination vitamin D therapy; Extraskeletal health; Skeletal quality; Vitamin D