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Review
. 2013 Mar;33(2):158-68.
doi: 10.1016/j.semnephrol.2012.12.016.

Impaired vitamin D metabolism in CKD

Cortney Bosworth  1 , Ian H de Boer
Affiliations
Review

Impaired vitamin D metabolism in CKD

Cortney Bosworth et al. Semin Nephrol. 2013 Mar.

Abstract

Vitamin D metabolism consists of both production and catabolism, which are enzymatically driven and highly regulated. Renal vitamin D metabolism requires filtration and tubular reabsorption of 25-hydroxyvitamin D and is regulated by parathyroid hormone, fibroblast growth factor-23, and 1,25-dihydroxyvitamin D. In chronic kidney disease, renal production of 1,25-dihydroxyvitamin D from 25-hydroxyvitamin D is reduced. In addition, pharmacokinetic studies and epidemiologic studies of 24,25-dihydroxyvitamin D, the most abundant product of 25-hydroxyvitamin D catabolism by CYP24A1, suggest that vitamin D catabolism also is reduced. New insights into the mechanisms and regulation of vitamin D metabolism may lead to novel approaches to assess and treat impaired vitamin D metabolism in chronic kidney disease.

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Figures

Figure 1
Figure 1
Production of 1,25(OH)2D. UV-B, ultraviolet B radiation.
Figure 2
Figure 2
Catabolism of 1,25(OH)2D and 25(OH)D. 25(OH)D3, 25-hydroxyvitamin D3; 1,25(OH)2D3, 1,25-dihydroxyvitamin D3; 23,25(OH)2D3, 23,25-dihydroxyvitamin D3; 24,25(OH)2D3, 24,25-dihydroxyvitamin D3; 1,23,25(OH)3D3, 1,23,25-trihydroxyvitamin D3; 1,24,25(OH)3D3, 1,24,25-trihydroxyvitamin D3; 24,25,26,27-tetranor-23(OH)D, 24,25,26,27-tetranor-23-hydroxyvitamin D.
Figure 3
Figure 3
Feedback regulation of vitamin D metabolism. 24,25(OH)2D3, 24,25-dihydroxyvitamin D3; 25(OH)D3, 25-hydroxyvitamin D3; 1,25(OH)2D3, 1,25-dihydroxyvitamin D3; PTH, parathyroid hormone; FGF-23, fibroblast growth factor-23.
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