Vitamin D: A Bridge between Kidney and Heart

Abstract

Chronic kidney disease (CKD) and cardiovascular disease (CVD) are highly prevalent conditions, each significantly contributing to the global burden of morbidity and mortality. CVD and CKD share a great number of common risk factors, such as hypertension, diabetes, obesity, and smoking, among others. Their relationship extends beyond these factors, encompassing intricate interplay between the two systems. Within this complex network of pathophysiological processes, vitamin D has emerged as a potential linchpin, exerting influence over diverse physiological pathways implicated in both CKD and CVD. In recent years, scientific exploration has unveiled a close connection between these two prevalent conditions and vitamin D, a crucial hormone traditionally recognized for its role in bone health. This article aims to provide an extensive review of vitamin D's multifaceted and expanding actions concerning its involvement in CKD and CVD.

Keywords: calcidiol; calcitriol; cardiovascular disease; hypertension; kidney disease; metabolic disease; mineral bone disease; osteoporosis; vitamin D.

Figure 1

The dimer formed by 1,25(OH)2D3–VDR2 interacts with the retinoid X receptor (RXR) and translocates into the nucleus. Within the nucleus, it attaches to vitamin D response elements (VDRE) found in the promoter region of specific genes. 25(OH)D obtained from the bloodstream can be converted locally into 1,25(OH) D within cells expressing 1α-hydroxylase. Adapted from Latic [29].

Figure 2

Mechanisms underlying vitamin D deficiency in CKD. VDBP: vitamin D binding protein. Adapted from Brandenburg [57].

Figure 3

Schematic representation of vitamin D inhibition of RAAS. ACE, angiotensin-converting enzyme; AT1, angiotensin receptor type 1; PRR, prorenin receptor; TACE, tumor necrosis factor α-converting enzyme.

Figure 4

Schematic representation of main vitamin D roles in CVD. RAAS, renin–angiotensin–aldosterone system; HF, heart failure; PTH, parathyroid hormone.