Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease
- PMID: 27190392
- DOI: 10.1093/ndt/gfw080
Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease
Erratum in
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Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease.Nephrol Dial Transplant. 2021 Feb 20;36(3):566-567. doi: 10.1093/ndt/gfaa172. Nephrol Dial Transplant. 2021. PMID: 32869097 No abstract available.
Abstract
Insufficiency of 25-hydroxyvitamin D [25(OH)D] is highly prevalent among patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) and is a critical component in the pathogenesis of secondary hyperparathyroidism. Accordingly, current National Kidney Foundation-Kidney Disease Outcomes Quality Initiative and Kidney Disease: Improving Global Outcomes guidelines recommend the correction of hypovitaminosis D through nutritional vitamin D replacement as a first-step therapeutic approach targeting secondary hyperparathyroidism. In this Polar Views debate, we summarize the existing evidence, aiming to defend the position that nutritional vitamin D replacement is not evidence-based and should not be applied to patients with CKD. This position is supported by the following: (i) our meta-analysis of randomized controlled trials shows that whereas nutritional vitamin D significantly increases serum 25(OH)D levels relative to placebo, there is no evidence either in predialysis CKD or in ESRD that parathyroid hormone (PTH) is lowered; (ii) on the other hand, in randomized head-to-head comparisons, nutritional vitamin D is shown to be inferior to activated vitamin D analogs in reducing PTH levels; (iii) nutritional vitamin D is reported to exert minimal to no beneficial actions in a series of surrogate risk factors, including aortic stiffness, left ventricular mass index (LVMI), epoetin utilization and immune function among others; and (iv) there is no evidence to support a benefit of nutritional vitamin D on survival and other 'hard' clinical outcomes. Whereas nutritional vitamin D replacement may restore 25(OH)D concentration to near normal, the real target of treating vitamin D insufficiency is to treat secondary hyperparathyroidism, which is untouched by nutritional vitamin D. Furthermore, the pleotropic benefits of nutritional vitamin D remain to be proven. Thus, there is little, if any, benefit of nutritional vitamin D replacement in CKD.
Keywords: CKD; cholecalciferol; nutritional vitamin D; secondary hyperparathyroidism.
Published by Oxford University Press on behalf of ERA-EDTA 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Comment in
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Opponent's comments.Nephrol Dial Transplant. 2016 May;31(5):713. doi: 10.1093/ndt/gfw080a. Nephrol Dial Transplant. 2016. PMID: 27190393 No abstract available.
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Moderator's view: Vitamin D deficiency treatment in advanced chronic kidney disease: a close look at the emperor's clothes.Nephrol Dial Transplant. 2016 May;31(5):714-6. doi: 10.1093/ndt/gfw081. Nephrol Dial Transplant. 2016. PMID: 27190394
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