title: Vitamin D in patients with chronic kidney disease: a position statement of the Working Group "Trace Elements and Mineral Metabolism" of the Italian Society of Nephrology.
abstract: In the late 1970s, calcitriol was introduced into clinical practice for the management of secondary renal hyperparathyroidism in chronic kidney disease (CKD). Since then, the use of calcifediol or other native forms of vitamin D was largely ignored until the publication of the 2009 Kidney Disease Improving Global Outcomes (KDIGO) recommendations. The guidelines suggested that measurement of circulating levels of 25(OH)D (calcifediol) and its supplementation were to be performed on the same basis as for the general population. This indication was based on the fact that the precursors of active vitamin D had provided to CKD patients considerable benefits in survival, mainly due to their pleiotropic effects on the cardiovascular system. However, despite the long-term use of various classes of vitamin D in CKD, a clear definition is still lacking concerning the most appropriate time for initiation of therapy, the best compound to prescribe (active metabolites or analogs), the proper dosage, and the most suitable duration of therapy. The aim of this position statement is to provide and critically appraise the current plentiful evidence on vitamin D in different clinical settings related to CKD, particularly focusing on outcomes, monitoring and treatment-associated risks. However, it should be taken in account that position statements are meant to provide guidance; therefore, they are not to be considered prescriptive for all patients and, importantly, they cannot replace the judgment of clinicians.
authors.affiliation: Nephrology, Dialysis and Renal Transplantation Unit, University Hospital "Policlinico", Bari, Italy. lfmorrone@gmail.com.
authors.forename: Luigi Francesco
authors.initials: LF
authors.lastname: Morrone
authors.affiliation: Territorial Unit of Nephrology and Dialysis-ASL 8 of Cagliari, Cagliari, Italy.
authors.forename: Pergiorgio
authors.initials: P
authors.lastname: Bolasco
authors.affiliation: Operative Unit of Nephrology, AO Spedali Civili di Brescia and University of Brescia, Brescia, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Camerini
authors.affiliation: Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cianciolo
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
authors.affiliation: Renal Unit, AO Desio-Vimercate, Desio, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Galassi
authors.affiliation: Department of Cardiovascular Respiratory Nephrologic Anesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mazzaferro
authors.affiliation: Department of Public Health, Unit of Nephrology and Hypertension, University of Naples Federico II, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.affiliation: Department of Public Health, Unit of Nephrology and Hypertension, University of Naples Federico II, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Russo
authors.affiliation: Renal Division and Laboratory of Experimental Nephrology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
mesh_terms: D001847:Bone Diseases / Q000188:drug therapy; D019587:Dietary Supplements; D006801:Humans; D016030:Kidney Transplantation; D008903:Minerals / Q000378:metabolism; D010281:Parathyroid Hormone / Q000097:blood; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D014131:Trace Elements / Q000378:metabolism; D061205:Vascular Calcification / Q000209:etiology; D014807:Vitamin D / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D008903:Minerals; D010281:Parathyroid Hormone; D014131:Trace Elements; D014807:Vitamin D
keywords: Chronic kidney disease; Dialysis; Kidney transplantation; Vitamin D