Chapter

Vitamin D metabolism and action in CKD

Ishir Bhan, Kevin J. Martin and Ravi Thadhani

in The Spectrum of Mineral and Bone Disorders in Chronic Kidney Disease

Second edition

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199559176
Published online November 2012 | e-ISBN: 9780191753350 | DOI: http://dx.doi.org/10.1093/med/9780199559176.003.008

Series: Oxford Clinical Nephrology Series

Vitamin D metabolism and action in CKD

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Chronic kidney disease is associated with progressive derangement of several metabolic processes, including multiple stages of vitamin D metabolism. These changes lead to deficiency in both 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, which in turn can contribute to hypocalcemia, hyperphosphatemia, secondary hyperparathyroidism, and bone loss. Recent studies point to additional effects beyond the traditional axis of mineral metabolism. Active vitamin D appears to ameliorate LVH and may suppress activity of the renin-angiotensin-aldosterone axis. Vitamin D also appears to be important in the regulation of both antimicrobial peptides that contribute to innate immunity and to anti-inflammatory cytokines that moderate the immune response. Several retrospective observational studies in both dialysis and pre-dialysis CKD suggest a survival benefit associated with vitamin D use. Prospective randomized controlled trials, currently underway, are needed to better define the risks and benefits of exogenous vitamin D in CKD.

Chapter.  5329 words.  Illustrated.

Subjects: Rheumatology ; Nephrology

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