Vitamin D and kidney disease

Abstract

Calcium and phosphorus are essential minerals required for many critical biologic functions including cell signaling, energy metabolism, skeletal growth and integrity. Calcium and phosphate homeostasis are maintained primarily by regulation of epithelial calcium and phosphate cotransport in the kidney and intestine, processes that are tightly regulated by hormones including 1,25 dihydroxyvitamin D (1,25(OH)2D), fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH). In patients with chronic kidney disease (CKD), as renal function declines, disruption of feedback loops between these hormones have adverse consequences on several organ systems, including the skeleton, heart and vascular system. CKD-associated mineral and bone disorder (CKD-MBD) is defined as a systemic disorder of mineral and bone metabolism due to CKD manifested by abnormalities of calcium, phosphorus, PTH or vitamin D metabolism, abnormalities of bone turnover, mineralization and volume, and ectopic soft tissue calcification. Complications of CKD-MBD include vascular calcification, stroke, skeletal fracture and increased risk of death. Increased FGF23 and PTH concentrations, and 1,25(OH)2D deficiency contribute to the pathogenesis of CKD-MBD. Therefore, treatment of patients with CKD-MBD is focused on restoring the feedback loops to maintain normal calcium and phosphate balance to prevent skeletal and cardiovascular complications.

The Effect of Monthly Vitamin D Replacement on Bone Turnover Parameters and Inflammation Parameters in Hemodialysis Patients

“…Causes and risk factors of 25 (OH) vitamin D deficiency/insufficiency in chronic kidney disease are age, adiposity, proteinuria, female gender, decreased vitamin D receptor, tubular reabsorption peritoneal dialysis, of 25(OH) D and deterioration of hydroxylation vitamin D (9). Vitamin D deficiency/insufficiency is associated with secondary hyperparathyroidism and bone cycle markers seen in CKD, low bone mineral density, atherosclerosis, weakened immunity, the progression of kidney disease and mortality results (10,11). Vitamin D deficiency causes a decrease in intestinal absorption of calcium and phosphorus value.…”

Investigating The Effects Of Diet-Induced Pre-Diabetes On Calciotropic Hormones In Male Sprague Dawley Rats

“…Vitamin D is a fat-soluble vitamin that plays a signi cant role in regulating whole body calcium homeostasis within the endocrine system [49]. Vitamin D is the precursor molecule needed for calcitriol synthesis [49].…”

“…Vitamin D is a fat-soluble vitamin that plays a signi cant role in regulating whole body calcium homeostasis within the endocrine system [49]. Vitamin D is the precursor molecule needed for calcitriol synthesis [49]. Calcitriol is vitamin D in its hormonally active form responsible for increasing plasma calcium concentrations [49].…”

Pengelolaan Gangguan Mineral Tulang pada Penyakit Ginjal Kronik

“…Normalisasi serum fosfat harus dilakukan sebelum inisiasi terapi dengan vitamin D aktif atau vitamin D analog. 9,18,57,58 Pada pasien dialisis yang membutuhkan terapi untuk menurunkan PTH, pemberian calcimimetics, calcitriol, atau vitamin D analog, atau kombinasi calcimimetics dengan calcitriol atau vitamin D analog dianjurkan. 16 Cinacalcet telah menunjukkan kontribusinya dalam menurunkan kadar PTH, kalsium, dan fosfat.…”