Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies

Pedro Henrique Franca Gois, Martin Wolley, Dwarakanathan Ranganathan and Antonio Carlos Seguro
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Pedro Henrique Franca Gois: Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston QLD 4029, Australia
Martin Wolley: Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston QLD 4029, Australia
Dwarakanathan Ranganathan: Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston QLD 4029, Australia
Antonio Carlos Seguro: Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, CEP 01246-903, Brazil

IJERPH, 2018, vol. 15, issue 8, 1-16

Abstract: Vitamin D (VD) is a pro-hormone essential for life in higher animals. It is present in few types of foods and is produced endogenously in the skin by a photochemical reaction. The final step of VD activation occurs in the kidneys involving a second hydroxylation reaction to generate the biologically active metabolite 1,25(OH) 2 -VD. Extrarenal 1α-hydroxylation has also been described to have an important role in autocrine and paracrine signaling. Vitamin D deficiency (VDD) has been in the spotlight as a major public healthcare issue with an estimated prevalence of more than a billion people worldwide. Among individuals with chronic kidney disease (CKD), VDD prevalence has been reported to be as high as 80%. Classically, VD plays a pivotal role in calcium and phosphorus homeostasis. Nevertheless, there is a growing body of evidence supporting the importance of VD in many vital non-skeletal biological processes such as endothelial function, renin-angiotensin-aldosterone system modulation, redox balance and innate and adaptive immunity. In individuals with CKD, VDD has been associated with albuminuria, faster progression of kidney disease and increased all-cause mortality. Recent guidelines support VD supplementation in CKD based on extrapolation from cohorts conducted in the general population. In this review, we discuss new insights on the multifactorial pathophysiology of VDD in CKD as well as how it may negatively modulate different organs and systems. We also critically review the latest evidence and controversies of VD monitoring and supplementation in CKD patients.

Keywords: Vitamin D; Vitamin D deficiency; chronic kidney disease; proteinuria (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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