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Vitamin D and kidney disease Al-Badr W; Martin KJClin J Am Soc Nephrol 2008[Sep]; 3 (5): 1555-60Abnormalities in vitamin D metabolism play a major role in the pathogenesis of secondary hyperparathyroidism in chronic kidney disease. The gradual and progressive decline in 1,25-dihydroxyvitamin D in the course of chronic kidney disease is the result of several mechanisms that limit the ability of the failing kidney to maintain the levels of 1,25-dihydroxyvitamin D despite increasing levels of parathyroid hormone. Recent observations have indicated that chronic kidney disease seems to be associated with a high incidence of nutritional vitamin D insufficiency or deficiency as manifested by decreased levels of 25-hydroxyvitamin D. This contributes to the inability to maintain the levels of 1,25-dihydroxyvitamin D; therefore, current practice guidelines suggest repleting vitamin D status by the administration of native vitamin D as a first step in the therapy of the abnormalities of bone and mineral metabolism in chronic kidney disease. The efficacy of this therapy is extremely variable, and active vitamin D sterols may be required, especially as kidney disease progresses. The importance of the abnormal vitamin D metabolism is being investigated vigorously in view of the observations that vitamin D may have important biologic actions in many tissues in addition to bone and parathyroid. Thus, observational data have suggested potential survival benefits of vitamin D sterol administration in this clinical setting, and experimental data have suggested a potential beneficial effect of vitamin D sterols on the progression of kidney disease. Further work is required to define the mechanisms involved and to examine the effects of vitamin D therapy on outcomes in randomized, controlled trials.|Chronic Disease[MESH]|Ergocalciferols/therapeutic use[MESH]|Evidence-Based Medicine[MESH]|Humans[MESH]|Hyperparathyroidism, Secondary/drug therapy/*etiology/metabolism[MESH]|Kidney Diseases/complications/*drug therapy/metabolism/mortality[MESH]|Practice Guidelines as Topic[MESH]|Treatment Outcome[MESH]|Vitamin D Deficiency/complications/*drug therapy/metabolism/mortality[MESH]|Vitamin D/metabolism/*therapeutic use[MESH]|Vitamins/metabolism/*therapeutic use[MESH] |
