Kidney diseases and COVID-19 infection: causes and effect, supportive therapeutics and nutritional perspectives
Heliyon, 19 Jan 2021, 7(1) DOI: 10.1016/j.heliyon.2021.e06008
Askari H1, Sanadgol N2, Azarnezhad A3, Tajbakhsh A4, Rafiei H5, Safarpour AR1, Gheibihayat SM6, Raeis-Abdollahi E7, Savardashtaki A4, Ghanbariasad A8, Omidifar N9
Table of contents
Overview Kidney and vitamin D contains the following summary
- FACT: Kidney is the primary way to activate vitamin D
- FACT: When the Kidney has problems, there is less active vitamin D (Calcitriol) for the body
- FACT: When the Kidney has problems, there is increased death due to many factors - many of which are associated with lack of Calcitriol
- FACT: There are many on-going intervention clinical trials trying to determine how much of what kind of vitamin D is needed to treat the problem
- FACT: One Randomized Controlled Trial has proven that Vitamin D treats CKD
- FACT: 38% of seniors have Chronic Kidney Disease and most are unaware of it CDC statistics 2020
- FACT: Taking extra Vitamin D, in various forms, does not cause health problems - even if poor kidney
- Suggestion: Increase vitamin D getting into body now - and increase co-factors so that the vitamin D can be better used
Sun, UV lamp, Vitamin D supplement - probably > 5,000 IU,
Calcitriol - which bypasses the need for the kidney to activate vitamin D
Problems with Calcitriol however: typically only lasts for a few hours, also, possible complications
Update: Pre-cursor of active vitamin D made from plants is better than calcitriol – Sept 2012
- Category Kidney and Vitamin D contains
Kidney category starts with:Kidney category listing has
see also Overview Kidney and vitamin DCalcitriol category listing has
Search VitaminDWiki for dialysis OR haemodialysis 878 items not in PDF as of Aug 2020
Search VitaminDWiki for kidney transplant 798 items as of June 2019
"Chronic Kidney Disease" OR CKD 874 items as of Jan 2018
48 items along with related searches
Kidney Intervention trials using Vitamin D:
- Chronic Kidney Disease (stage 3) slowed by 30 ng of Vitamin D and Calcitriol – Dec 2019
- Diabetic nephropathy (Kidney) treated by 50,000 IU of vitamin D weekly – RCT Jan 2019
- Hemodialysis patients (CKD) helped by weekly 50,000 IU of vitamin D – Jan 2017
- Kidney disease helped by active or high dose Vitamin D - Feb 2014
- Peritoneal Dialysis nicely treated by active vitamin D – July 2013
- 7100 IU (50000 weekly) restored vitamin D levels for those with Chronic Kidney Disease – July 2012
- Chronic Kidney Disease reduced with 3600 IU vitamin D (50000 twice a month)– RCT Aug 2012
- Overview Kidney and vitamin D
- Blacks have 4X more Kidney disease than whites – probably due to low vitamin D – March 2015
- Chronic Kidney Disease decreases Vitamin D in 4 ways – Nov 2017
- Vitamin D activation is mainly done by the tissues, not the Kidneys
- More than 30 ng of vitamin D is sometimes needed (Kidney needs 50 ng) – March 2019
- 1 in 10 have Chronic Kidney Disease – review Sept 2019
- Adding Vitamin D decreased kidney deaths by 4x – Dec 2010
Recently, the novel coronavirus disease 2019 (COVID-19), has attracted the attention of scientists where it has a high mortality rate among older adults and individuals suffering from chronic diseases, such as chronic kidney diseases (CKD). It is important to elucidate molecular mechanisms by which COVID-19 affects the kidneys and accordingly develop proper nutritional and pharmacological strategies. Although numerous studies have recently recommended several approaches for the management of COVID-19 in CKD, its impact on patients with renal diseases remains the biggest challenge worldwide. In this paper, we review the most recent evidence regarding causality, potential nutritional supplements, therapeutic options, and management of COVID-19 infection in vulnerable individuals and patients with CKD.
To date, there is no effective treatment for COVID-19-induced kidney dysfunction, and current treatments are yet limited to anti-inflammatory (e.g. ibuprofen) and anti-viral medications (e.g. Remdesivir, and Chloroquine/Hydroxychloroquine) that may increase the chance of treatment.
In conclusion, the knowledge about kidney damage in COVID-19 is very limited, and this review improves our ability to introduce novel approaches for future clinical trials for this contiguous disease.
Once vitamin D is produced either in the skin from 7-DHC or absorbed from the diet, it must be activated first to 25OHD and then to its active form 1,25(OH)2D in a multistage liver and kidney metabolisms. The production of vitamin D is not enzymatic but depends on UVB . Vitamin D is a fat-soluble essential vitamin that has a substantial role in promoting innate immune responses and suppressing adaptive immune responses (Figure 4) . Multiple cross-sectional studies have shown that vitamin D deficiency is associated with increased susceptibility to serious viral respiratory tract infections . The beneficial effects of vitamin D on protective immunity are partly due to crosstalk between vitamin D metabolism, VDR signaling, and innate immunity, where TLR binding leads to increased expression of both 1-a-hydroxylase and VDR. This results in the binding of the 1,25 D-VDR-RXR heterodimer to the VDREs of the genes for cathelicidin and beta-defensin 4 and subsequent transcription of these proteins . Immune responses may be enhanced by cathelicidin and some p-defensins that not only act against microbes, but also have chemoattractant capabilities, leading to recruitment of neutrophils, monocytes, and other immune cell molecules to the site of infection (Figure 4). Vitamin D substantially exerts a modulatory role in the adaptive immune system. Recently, studies evaluating 157 potential mechanisms showed that vitamin D plays a pivotal inhibitory role in the innate immune sensing of respiratory viral infections, e.g., influenza A and B, parainfluenza 1 and 2, and respiratory syncytial virus (RSV). A systematic review which that included 39 studies on the function of vitamin D in the prevention of respiratory tract infections showed a statistically significant association between low vitamin D status and increased risk of either upper and lower respiratory tract infections . However, several RCTs revealed conflicting findings regarding this association, possibly due to regimens heterogeneity and baseline serum vitamin D level . An RCT evaluating the effect of high-dose (2000 IU) each day versus standard-dose (400 IU) each day vitamin D supplementation showed no significant difference between the two groups on viral upper respiratory tract infections . However, a recent report on the effect of vitamin D supplements on influenza vaccine response among vitamin D deficient elderly individuals exert a lymphocyte polarization into a tolerogenic immune response, where it promoted a higher TGFp plasma level without ameliorating antibody production . Furthermore, researchers suggest that, a monthly supplementation with high-dose (100,000 IU) per month versus standard-dose group (12,000 IU) per month vitamin D reduced the incidence of acute respiratory infections . It has been shown that the protective effect of vitamin D on antiviral immunity against respiratory infections is presumably dependent on the vitamin D level of the subject in which vitamin D-deficient individuals would benefit more. Given the higher mortality rate from COVID-19 in some countries compared to others, comparing data across nations is complicated. Vitamin D status of populations is one mostly overlooked factor that could be related to the outcome of COVID-19.
A growing body of circumstantial evidence has now specifically linked outcomes of COVID-19 with vitamin D status . The role of vitamin D in the response to COVID-19 infection could be two-fold.
- First, antimicrobial peptides (AMPs) production in the respiratory epithelium is supported with vitamin D, making infection with the virus and progression ofCOVID-19 signs less likely.
- Second, vitamin D might help to reduce the inflammatory response to infection with SARS-CoV-2 . Cytokine storm, organ system interaction, and systemic effects are the possible mechanisms of renal injury in patients with Covid-19.
The main function of the kidneys is to remove wastes and excess water from the body. It is reported that patients with kidney disease often have low levels of vitamin D in their blood [105, 106]. Furthermore, people with reduced kidney function develop alterations levels of phosphorus and calcium in the blood. Gradual loss of kidney function leading to the inability to get rid of phosphorus into tubules and inactivation of vitamin D, to maintain normal levels of calcium. These changes are sensed by the parathyroid gland and calcium is increased through the elevating production and release of parathyroid hormone. Accordingly, bone metabolism is altered by these metabolic changes to release calcium and accordingly lead to bone abnormalities and, therefore bone deformation, bone pain, and altered risks of fracture may occur . A recent report indicated that even short-term acute vitamin D deficiency could directly lead to hypertension and impacts on renin-angiotensin system components that result in kidney injury. In cases with CKD, vitamin D deficiency has frequently been associated with proteinuria, albuminuria, progression to end-stage renal disease (ESRD) and increased risk for all-cause mortality (Figure 4).Kidney diseases and COVID-19 – probably helped by Vitamin D etc. – Jan 19, 2021
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