Am J Kidney Dis. 2012 May 4.
Nigwekar SU, Bhan I, Thadhani R.
Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Scholars in Clinical Science Program, Harvard Medical School, Boston, MA.
The development of chronic kidney disease (CKD) is accompanied by a progressive decrease in the ability to produce 1,25-dihydroxyvitamin D. Pharmacological replacement with active vitamin D therefore has been a cornerstone of secondary hyperparathyroidism therapy in the end-stage renal disease population treated by long-term dialysis. Recent evidence suggests that extrarenal conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D may have significant biological roles beyond those traditionally ascribed to vitamin D. Furthermore, low 25-hydroxyvitamin D levels are common in patients with all stages of CKD. This article focuses on the role of nutritional vitamin D replacement in CKD and aims to review vitamin D biology and summarize the existing literature regarding nutritional vitamin D replacement in these populations. Based on the current state of the evidence, we provide suggestions for clinical practice and address areas of uncertainty that need further research.
Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.