Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

Abstract

Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.

Analysis of the impact of underlying diseases in the elderly on postoperative re-fractures after osteoporotic compression fractures

“…According to the theory of traditional Chinese medicine, "the kidney is the master of bone", and people with chronic kidney disease (CKD) (OR = 2.208, 95% CI = 1.323-3.686, P < 0.002)have a higher risk of multifactorial VD deficiency, which is closely associated with poor outcomes, including bone disease, cardiovascular disease and higher mortality [19]. The finding that in patients with chronic kidney disease, decreased renal compensatory function increases the risk of osteoporotic re-fracture is also in line with conventional medical opinion.…”

Chronic Kidney Disease with Mineral Bone Disorder and Vascular Calcification: An Overview

“…Vitamin D deficiency, defined as a calcidiol serum level <20 ng/mL [ 32 ], is common in both CKD and the earlier phases of ESKD. It is associated with poor renal outcomes and increased mortality [ 21 , 28 , 33 ].…”

Hipovitaminose D e Doença Renal Crônica: uma revisão de literatura

“…Apesar de as metas de níveis de VD em pacientes em tratamento ainda serem motivo de discussões e controvérsias, o que se encontra bem estabelecido é o uso da VD nativa para correção dos baixos níveis desses compostos, ou seja, o uso de colecalciferol e ergocalciferol, por exemplo. No caso de pacientes com osteoporose a suplementação, tanto de vitamina D como abordagem a respeito da ingestão de adequadas quantidades de cálcio devem ser consideradas (BOVER et al, 2023). Para pacientes com DRC e em diálise é recomenda a verificação dos níveis de (OH)VD e sua suplementação quando em níveis abaixo do esperado.…”

“…Sua definição de acordo com a taxa de filtração glomerular (TFGe) considera sua existência quando os valores se encontram inferiores a 60ml/min/1,73m². É causada por diversas afecções aos rins resultando em uma danificação funcional ou estrutural e, consequentemente, a diminuição da excreção de resíduos do organismo, bem como pode ter suas funções endócrinas afetadas (CHRISTODOULOU, ASPRAY, SCHOENMAKERS;BOVER et al;2021;2023).…”

“…Brazilian Journal of Health Review, Curitiba, v. 6, n. 4, p. 18135-18142, jul/aug., 2023 Além disso, a DRC influencia no aumento precoce do fator de crescimento de fibroblastos (FGF23) que é um hormônio advindo do osso com atuação no rim e que inibe a 1α-hidroxilase e ativa a 24-hidroxilase (CYP24A1), enzima de degradação, levando, assim, a uma baixa disponibilidade do calcitriol (BOVER et al, 2023).…”