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Vitamin D metabolism and action in CKD 

Vitamin D metabolism and action in CKD
Vitamin D metabolism and action in CKD

Ishir Bhan

, Kevin J. Martin

, and Ravi Thadhani

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date: 02 August 2021

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.

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