Raising awareness on the therapeutic role of cholecalciferol in CKD: a multidisciplinary-based opinion

Abstract

Vitamin D is recognized to play an essential role in health and disease. In kidney disease, vitamin D analogs have gained recognition for their involvement and potential therapeutic importance. Nephrologists are aware of the use of oral native vitamin D supplementation, however, uncertainty still exists with regard to the use of this treatment option in chronic kidney disease as well as clinical settings related to chronic kidney disease, where vitamin D supplementation may be an appropriate therapeutic choice. Two consecutive meetings were held in Florence in July and November 2016 comprising six experts in kidney disease (N = 3) and bone mineral metabolism (N = 3) to discuss a range of unresolved issues related to the use of cholecalciferol in chronic kidney disease. The panel focused on the following six key areas where issues relating to the use of oral vitamin D remain controversial: (1) vitamin D and parathyroid hormone levels in the general population, (2) cholecalciferol in chronic kidney disease, (3) vitamin D in cardiovascular disease, (4) vitamin D and renal bone disease, (5) vitamin D in rheumatological diseases affecting the kidney, (6) vitamin D and kidney transplantation.

Consensus statement from 2nd International Conference on Controversies in Vitamin D

“…The same findings have been reported for kidney transplant recipients, even in those with relatively well-preserved renal function [93]. Together with these findings, vitamin D deficiency has been associated with several complications of CKD, such as cardiovascular disease, anemia, proteinuria, progression of renal failure and disordered calcium metabolism [89,94]. After kidney transplantation, low levels of 25(OH)D serum levels are the most important predictor of the sustained increase in PTH levels, which persists in up to 50% of patients even many years after surgery [93].…”

“…More recently, vitamin D deficiency has been linked to a whole host of diseases, some related to CKD, prompting further exploration of the mechanism of action of active vitamin D analogues and, consequently, their potential benefit in clinical trials. However, many open questions regarding the use of native vitamin D or VDR activators remain [86][87][88][89]. First, the Kidney Disease Outcomes Quality Initiative (K/DOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend testing for vitamin D insufficiency and deficiency in CKD patients, but no consensus on the definition of vitamin D insufficiency in CKD is currently available [90].…”

“…First, the Kidney Disease Outcomes Quality Initiative (K/DOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend testing for vitamin D insufficiency and deficiency in CKD patients, but no consensus on the definition of vitamin D insufficiency in CKD is currently available [90]. Second, using native vitamin D in patients with CKD remains heavily debated, particularly with regard to the choice of compound, when to treat, and the most suitable dose to administer with or without VDR activators [89].…”

The role of vitamin D in perinatology. An up-to-date review

“…[3,33,35,[41][42][43]. Other illnesses, which are not less important, are chronic kidney disease (kidney failure), gastrointestinal illnesses, and liver failure [41,44].…”

Screening for hypovitaminosis D: cost-effective or not?

“…Indeed, even though there is universal agreement that individuals should not have 25(OH)D values less than 10 ng/mL (or 25 nmol/mL), there is an ongoing and never ending debate on what constitutes the threshold for sufficiency (i.e. 20 vs 30 ng/mL) (31,32,33,34,35). Another important point to consider is represented by the lack of randomized controlled trials that evaluated clinical outcomes or harms in persons screened versus those not screened for vitamin D deficiency (28).…”