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lüll Role of vitamin D in chronic kidney disease Patel TV; Singh AKSemin Nephrol 2009[Mar]; 29 (2): 113-21Decline in renal function is related directly to cardiovascular mortality. However, traditional risk factors do not fully account for the high mortality in these patients. Activated vitamin D, a hormone produced by the proximal convoluted tubule of the kidney, appears to have beneficial effects beyond suppressing parathyroid hormone (PTH). However, activated vitamin D also can cause hypercalcemia and hyperphosphatemia in chronic kidney disease. Newer agents such as vitamin D receptor activators (eg, paricalcitol) suppress PTH with reduced risk of hypercalcemia and hyperphosphatemia. Recent evidence from animal and preliminary human studies supports an association between vitamin D receptor activators and reduced risk of cardiovascular disease deaths, irrespective of PTH levels. New pathways of vitamin D regulation also have been discovered, involving fibroblast growth factor-23 and klotho. Although considerable work has been performed to advance our understanding of the effects of vitamin D in health and chronic kidney disease, more investigations and randomized trials need to be performed to elucidate the mechanistic underpinnings of these effects.|Animals[MESH]|Bone Density Conservation Agents/*therapeutic use[MESH]|Bone Diseases, Metabolic/*etiology/metabolism/prevention & control[MESH]|Calcitriol/therapeutic use[MESH]|Ergocalciferols/therapeutic use[MESH]|Humans[MESH]|Hyperparathyroidism, Secondary/etiology/metabolism/prevention & control[MESH]|Kidney Failure, Chronic/complications/*metabolism/therapy[MESH]|Prognosis[MESH]|Renal Dialysis[MESH]|Vitamin D/*physiology[MESH] |