Nutritional vitamin D in CKD: Should we measure? Should we treat?

Capelli, Irene; Cianciolo, Giuseppe; Gasperoni, Lorenzo; Galassi, Andrea; Ciceri, Paola; Cozzolino, Mario

doi:10.1016/j.cca.2019.11.010

Cited by 17 publications

(16 citation statements)

References 147 publications

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“…The majority of patients from nephrology at RMH were treated for chronic kidney disease (CKD). Vitamin D levels are generally low in these patients, as CKD is associated with low levels of vitamin D, especially in patients with end-stage renal disease and kidney transplant recipient 55–59. Our findings are consistent with results from previous studies that demonstrated the association between low vitamin D levels and CKD.…”

Section: Discussionsupporting

confidence: 91%

Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D

et al. 2020

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ObjectivesTo investigate whether sex, age, medical specialty and seasonal variations in serum concentration of 25-hydroxy vitamin D (25(OH)D) are evident among an Australian patient population.DesignRetrospective study analysing the results of serum 25(OH)D lab tests and vitamin D supplementation from Royal Melbourne Hospital (RMH) between 2014 and 2017.SettingTertiary healthcare centre in Victoria, Australia.Participants30 023 patients (inpatient and outpatient) who had their serum 25(OH)D levels measured at RMH between 2014 and 2017.Main outcome measuresSerum 25(OH)D levels stratified according to patients’ sex, age and medical specialty admitted to, as well as the season and year (2014 to 2017) 25(OH)D level was measured.ResultsMean serum 25(OH)D level of study population was 69.9 nmol/L (95% CI 69.5 to 70.2). Only 40.2% patients in this cohort were sufficient in vitamin D (>75 nmol/L). On average, 25(OH)D levels in male patients were 6.1 units (95% CI 5.4 to 6.9) lower than in females. Linear regression analysis found that 25(OH)D levels increased by 0.16 unit (95% CI 0.14 to 0.18) for every year increase in age. One-way analysis of variance showed patients from neurology had the highest average 25(OH)D level, 76.8 nmol/L (95% CI 74.2 to 79.3) compared with other medical specialties. Mean 25(OH)D level during winter, 64.9 nmol/L (95% CI 64.2 to 65.6) was significantly lower compared with other seasons despite supplementation. Average 25(OH)D level measured in 2014, 71.5 nmol/L (95 CI% 70.8 to 72.2) was significantly higher than levels measured in 2016–2017.ConclusionsThere is a sex, age, medical specialty, seasonal and yearly variation in vitamin D status in an Australian patient population. The association between low vitamin D status and winter despite supplementation suggests other interventions are required to boost serum 25(OH)D levels.

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Section: Discussionsupporting

confidence: 91%

Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D

et al. 2020

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“…CKD–MBD after kidney transplantation is widely present and it is characterized by different metabolic and bone conditions, named post-transplantation bone disease (PTBD). PTBD results in poor bone quality, higher fracture risk, accelerated vascular aging, and deterioration of allograft function [ 71 , 72 ]. PTBD has a multifactorial etiopathogenesis which involves pre-existent CKD–MBD, derangements in the PTH–FGF23–vitamin D axis, metabolic alterations in calcium/phosphorus balance, and immunosuppressive therapy [ 69 ].…”

Section: Controversial Key Elements Regarding Vitamin D Status Assessment and Therapy Applications In Clinical Practicementioning

confidence: 99%

Vitamin D Effects on Bone Homeostasis and Cardiovascular System in Patients with Chronic Kidney Disease and Renal Transplant Recipients

et al. 2021

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Poor vitamin D status is common in patients with impaired renal function and represents one main component of the complex scenario of chronic kidney disease–mineral and bone disorder (CKD–MBD). Therapeutic and dietary efforts to limit the consequences of uremia-associated vitamin D deficiency are a current hot topic for researchers and clinicians in the nephrology area. Evidence indicates that the low levels of vitamin D in patients with CKD stage above 4 (GFR < 15 mL/min) have a multifactorial origin, mainly related to uremic malnutrition, namely impaired gastrointestinal absorption, dietary restrictions (low-protein and low-phosphate diets), and proteinuria. This condition is further worsened by the compromised response of CKD patients to high-dose cholecalciferol supplementation due to the defective activation of renal hydroxylation of vitamin D. Currently, the literature lacks large and interventional studies on the so-called non-calcemic activities of vitamin D and, above all, the modulation of renal and cardiovascular functions and immune response. Here, we review the current state of the art of the benefits of supplementation with native vitamin D in various clinical settings of nephrological interest: CKD, dialysis, and renal transplant, with a special focus on the effects on bone homeostasis and cardiovascular outcomes.

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“…Moreover, many observational and interventional studies reported that kidney transplant recipients are susceptible to low levels of VD [72]. A VD deficiency increases with the progression of CKD, and it accounts for 20% in CKD stage 3 and 30% in CKD stages 4-5 [73]. Interestingly, Cankaya et al demonstrated that PD and HD patients' VD levels were lower in comparison with CKD and renal transplant patients [74].…”

Section: Vitamin D Deficiency In Ckd Patientsmentioning

confidence: 99%

Vitamin K and D Supplementation and Bone Health in Chronic Kidney Disease—Apart or Together?

2021

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Vitamin K (VK) and vitamin D (VD) deficiency/insufficiency is a common feature of chronic kidney disease (CKD), leading to impaired bone quality and a higher risk of fractures. CKD patients, with disturbances in VK and VD metabolism, do not have sufficient levels of these vitamins for maintaining normal bone formation and mineralization. So far, there has been no consensus on what serum VK and VD levels can be considered sufficient in this particular population. Moreover, there are no clear guidelines how supplementation of these vitamins should be carried out in the course of CKD. Based on the existing results of preclinical studies and clinical evidence, this review intends to discuss the effect of VK and VD on bone remodeling in CKD. Although the mechanisms of action and the effects of these vitamins on bone are distinct, we try to find evidence for synergy between them in relation to bone metabolism, to answer the question of whether combined supplementation of VK and VD will be more beneficial for bone health in the CKD population than administering each of these vitamins separately.

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Nutritional vitamin D in CKD: Should we measure? Should we treat?

Cited by 17 publications

References 147 publications

Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D

Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D

Vitamin D Effects on Bone Homeostasis and Cardiovascular System in Patients with Chronic Kidney Disease and Renal Transplant Recipients

Vitamin K and D Supplementation and Bone Health in Chronic Kidney Disease—Apart or Together?

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