Dietary Reference Intakes for Calcium and Vitamin D

Viswanath, Deepak

doi:10.17226/13050

Cited by 272 publications

(145 citation statements)

References 26 publications

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“…These findings confirm the data reported in the biggest retro spective observational study analyzing VD and mortality in CKD patients. Navaneethan et al [40] Taking all these data together, we agree with the Institute of Medicine recommendation to consider sufficient 25(OH)D levels of at least 20 ng/mL, given that serum 25(OH)D concentrations above 30 ng/ mL are not consistently associated with increased benefit [27,40] . In addition, most clinical trials have only confirmed the neutral effect of VD supplementation on hard outcomes [41] , whereas some controlled studies have shown positive results in spite of the mean VD concentration not reaching the optimal recommended levels of ≥ 30 ng/mL [16] .…”

supporting

confidence: 60%

“…Estimating optimal vitamin D status in CKD (75-100 nmol/L) to be desirable, levels at which PTH is suppressed to a minimum in its relation to 25(OH)D [25,26] . By contrast, the Institute of Medicine advocates VD repletion as a level of 20 ng/mL [27] . Determining the 25(OH)D target level for optimal health is especially important in CKD population, where overuse of VD leads to hypercalcemia, hypercalciuria and hyperphosphatemia, which could predispose to vascular calcification, nephro lithiasis and reduced glomerular filtration rate [28][29][30] .…”

Section: Hydroxyvitamin D [25(oh)d]mentioning

confidence: 98%

“…Moreover, VD might not be safe in all settings, and supplementing could cause harm in people with CKD, who have a high prevalence of vascular calcification, and a decreasing ability for renal excretion of calcium and phosphorous [32,42] . Excessive VD supplementation may be particularly harmful in those high risk individuals with serum 25(OH)D levels above 20 ng/mL which are classified as insufficient according to current guidelines, and who then are treated with high-dose supplements of VD containing many times the levels of intake recommended for adults (600-800 UI/d) [18,27,43] . Although some experts suggest that it is safe to carry higher vitamin D levels (40-70 ng/mL), this recommendation is based on acute and not long-term observations [44] .…”

mentioning

confidence: 99%

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What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

Molina¹,

Górriz²,

Molina³

et al. 2016

WJN

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AIMTo evaluate thresholds for serum 25(OH)D concentrations in relation to death, kidney progression and hospitalization in non-dialysis chronic kidney disease (CKD) population. METHODSFour hundred and seventy non-dialysis 3-5 stage CKD patients participating in OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into 3 groups according to 25(OH)D levels at enrollment (less than 20 ng/mL, between 20 and 29 ng/mL, and at or above 30 ng/mL), considering 25(OH)D between 20 and 29 ng/mL as reference group. Association between 25(OH)D levels and death (primary outcome), and time to first hospitalization and renal progression (secondary outcomes) over a 3-year followup, were assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. To identify 25(OH)D levels at highest risk for outcomes, receiver operating characteristic (ROC) curves were performed. RESULTSOver 29 ± 12 mo of follow-up, 46 (10%) patients dead, 156 (33%) showed kidney progression, and 126 (27%) were hospitalized. After multivariate adjustment, 25(OH)D < 20 ng/mL was an independent predictor of all-cause mortality (HR = 2.33; 95%CI: 1.10-4.91; P = 0.027) and kidney progression (HR = 2.46; 95%CI: 1.63-3.71; P < 0.001), whereas the group with 25(OH)D at or above 30 ng/mL did not have a different hazard for outcomes from the reference group. Hospitalization outcomes were predicted by 25(OH) levels (HR = 0.98; 95%CI: 0.96-1.00; P = 0.027) in the unadjusted Cox proportional hazards model, but not after multivariate adjusting. ROC curves identified 25(OH)D levels at highest risk for death, kidney progression, and hospitalization, at 17.4 ng/mL [area under the curve (AUC) = 0.60; 95%CI: 0.52-0.69; P = 0.027], 18.6 ng/mL (AUC = 0.65; 95%CI: 0.60-0.71; P < 0.001), and 19.0 ng/mL (AUC = 0.56; 95%CI: 0.50-0.62; P = 0.048), respectively. CONCLUSION 25(OH)D < 20 ng/mL was an independent predictor of death and progression in patients with stage 3-5 CKD, with no additional benefits when patients reached the levels at or above 30 ng/mL suggested as optimal by CKD guidelines. Core tip: This study examines the prognosis value of 25(OH)D levels on death, chronic kidney disease (CKD) progression, and hospitalization in a cohort of 3-5 stage CKD subjects not on dialysis. The main findings were the predictor value of vitamin D deficiency (< 20 ng/ mL), but not insufficiency (< 30 ng/mL), for the 3-year incidence of death and CKD progression, which remained significant after multivariate adjustments. These results could highlight the need for a revision of the current guidelines, which have defined optimal vitamin D status at ≥ 30 ng/mL based on levels required to suppress parathyroid hormone, as opposed to our study, which evaluates thresholds for serum 25(OH)D concentrations in relation to "hard" endpoints.

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supporting

confidence: 60%

Section: Hydroxyvitamin D [25(oh)d]mentioning

confidence: 98%

mentioning

confidence: 99%

See 1 more Smart Citation

What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

Molina¹,

Górriz²,

Molina³

et al. 2016

WJN

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“…24 National strategies, such as the Centers for Disease Control’s “Stopping Elderly Accidents, Deaths & Injuries” (STEADI) initiative, 25 have assembled educational materials for patients and health care providers but their integration into practice on a system level has been inconsistent. The STRIDE intervention, embedded in the context of a pragmatic trial, is an attempt to engage health care systems in evaluating and modifying risk factors for serious falls-related injuries by changing the care of older persons who are at risk of these injuries.…”

Section: Discussionmentioning

confidence: 99%

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co‐management

Reuben

Gazarian

Alexander

et al. 2017

J American Geriatrics Society

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In response to the epidemic of falls and serious falls-related injuries among older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects of a multifactorial intervention and an enhanced usual care intervention. The STRIDE multifactorial intervention consists of 5 major components delivered by registered nurses in the role of Falls Care Managers (FCM), who co-manage fall risk in partnership with patients and their primary care providers (PCP). The components include: 1) standardized assessment of 8 modifiable risk factors (medications, postural hypotension, feet and footwear, vision, vitamin D, osteoporosis, home safety, and strength, gait, and balance impairment) and the use of protocols and algorithms to generate recommended management of risk factors; 2) explanation of assessment results to the patient (and caregiver when appropriate) using basic motivational interviewing techniques to elicit patient priorities, preferences, and readiness to participate in treatments; 3) co-creation of individualized Falls Care Plans that are reviewed, modified, and approved by patients’ PCPs; 4) implementation of the Falls Care Plan; and 5) ongoing monitoring of response, regularly scheduled re-assessments of fall risk, and revisions of the Falls Care Plan. Custom-designed falls care management software facilitates risk factor assessment, the identification of recommended interventions, clinic note generation, and longitudinal care management. The trial testing the effectiveness of the STRIDE intervention is in progress with results expected in late 2019.

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“…In the current study the general mean content of minerals in the investigated Ganoderma mushrooms decreased in the order K>Ca>P>Fe>Mg>Na>Zn>Mn>Cu. Nevertheless, if one considers the Recommended Daily Allowances (RDAs) for daily intake set by the Food and Nutrition Board [40], the total daily use of 1.5 g of dried Ganoderma (as recommended by most producers of food supplements based on these mushrooms) would constitute a rather low nutritional value in this regard for all the investigated essential elements. In this regard, none of investigated species could be considered as a sufficient source of minerals in the human diet.…”

Section: Discussionmentioning

confidence: 99%

Comparison of multielemental composition of Polish and Chinese mushrooms (Ganoderma spp.)

Siwulski

Rzymski

Niedzielski

et al. 2017

Eur Food Res Technol

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Dietary Reference Intakes for Calcium and Vitamin D

Cited by 272 publications

References 26 publications

What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co‐management

Comparison of multielemental composition of Polish and Chinese mushrooms (Ganoderma spp.)

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