Prevalence and Prognostic Implications of Vitamin D Deficiency in Chronic Kidney Disease

Abstract

Vitamin D is an important nutrient involved in bone mineral metabolism, and vitamin D status is reflected by serum total 25-hydroxyvitamin D (25[OH]D) concentrations. Vitamin D deficiency is highly prevalent in patients with chronic kidney disease (CKD), and nutritional vitamin D supplementation decreases elevated parathyroid hormone concentrations in subgroups of these patients. Furthermore, vitamin D is supposed to have pleiotropic effects on various diseases such as cardiovascular diseases, malignancies, infectious diseases, diabetes, and autoimmune diseases. Indeed, there is cumulative evidence showing the associations of low vitamin D with the development and progression of CKD, cardiovascular complication, and high mortality. Recently, genetic polymorphisms in vitamin D-binding protein have received great attention because they largely affect bioavailable 25(OH)D concentrations. This finding suggests that the serum total 25(OH)D concentrations would not be comparable among different gene polymorphisms and thus may be inappropriate as an index of vitamin D status. This finding may refute the conventional definition of vitamin D status based solely on serum total 25(OH)D concentrations.

Seasonal variations in transition, mortality and kidney transplantation among patients with end-stage renal disease in the USA

“…In addition to traditional risk factors, such as older age, hypertension and diabetes, several non-traditional, kidney disease-specific factors (i.e. oxidative stress, uremic toxins, compromised immunity, protein-energy wasting, hyperphosphatemia, vitamin D deficiency and fluid retention) may play roles in the development of these disease conditions and associated mortality risk [20][21][22][23]. Furthermore, cardiovascular and infectious events may also induce irreversible acute kidney injury in predialysis patients with advanced chronic kidney disease, resulting in the accelerated initiation of dialysis treatment in winter.…”

Fractures in patients with CKD—diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation

“…Several studies favored a higher vitamin D cutoff value in CKD patients in relation to the general population (Table 3). 56,66,68,69,[97][98][99][100][101] Overall, we believe that a higher 25OHD cutoff value might be necessary to prevent bone fractures, permitting a significant decrease in serum PTH and ameliorating bone biomarkers. Increased supplementation doses may be necessary to stimulate residual renal 1a-hydroxylase activity, to compensate for high osteoid activity, and to have a significant impact on reducing PTH.…”

αKlotho and Chronic Kidney Disease

“…3). Given that disturbed mineral metabolism contributes to the high morbidity and mortality of CV disease in CKD (Davidovich, Davidovits, Peretz, Shapira, & Aframian, 2009; Fernandez-Martin et al, 2015; Kaisar, Isbel, & Johnson, 2007; Kestenbaum & Belozeroff, 2007; London, Marchais, Guerin, & Metivier, 2005; Obi, Hamano, & Isaka, 2015; Siomou & Stefanidis, 2012; van Ballegooijen, Rhee, Elmariah, de Boer, & Kestenbaum, 2016; Wesseling-Perry, 2015), a better understanding of the molecular mechanisms of how αKlotho deficiency dysregulates mineral metabolism will aid in the exploration of novel therapeutic strategies in CKD.…”