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Vitamin D in Chronic Kidney Disease

  • Symposium on Pediatric Nephrology
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Vitamin D deficiency is widespread in both the pediatric and adult chronic kidney disease (CKD) population. CKD is characterized by dysregulation of vitamin D and mineral metabolism. Secondary hyperparathyroidism and its management puts patients with CKD at increased cardiovascular risk. Emergence of experimental and some clinical data suggesting beneficial effects of vitamin D on proteinuria, blood pressure, inflammation and cardiovascular outcomes has pushed it to the center stage of CKD research. Pediatric data on vitamin D dysregulation and its consequences are still in its infancy. Ongoing prospective studies such as Chronic Kidney disease in Children (CKiD) and the Cardiovascular Comorbidity in Children with CKD (4 C) should help to delineate the evolution of disturbances in mineral metabolism and its adverse effects on growth, CKD progression and cardiovascular outcomes.

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References

  1. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004;80:1689S–96S.

    PubMed  CAS  Google Scholar 

  2. Lips P. Vitamin D physiology. Prog Biophys Mol Biol. 2006;92:4–8.

    Article  PubMed  CAS  Google Scholar 

  3. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.

    Article  PubMed  CAS  Google Scholar 

  4. Brown AJ. Vitamin D analogs for secondary hyperparathyroidism: what does the future hold? J Steroid Biochem Mol Biol. 2007;103:578–83.

    Article  PubMed  CAS  Google Scholar 

  5. Correa P, Segersten U, Hellman P, Akerstrom G, Westin G. Increased 25-hydroxyvitamin D3 1alpha-hydroxylase and reduced 25-hydroxyvitamin D3 24-hydroxylase expression in parathyroid tumors–new prospects for treatment of hyperparathyroidism with vitamin D. J Clin Endocrinol Metab. 2002;87:5826–9.

    Article  PubMed  CAS  Google Scholar 

  6. Gonzalez EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am J Nephrol. 2004;24:503–10.

    Article  PubMed  CAS  Google Scholar 

  7. van Driel M, Koedam M, Buurman CJ, et al. Evidence for auto/paracrine actions of vitamin D in bone: 1alpha-hydroxylase expression and activity in human bone cells. FASEB J. 2006;20:2417–9.

    Article  PubMed  Google Scholar 

  8. Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess. 2007;158:1–235.

    Google Scholar 

  9. Bouillon R, Carmeliet G, Verlinden L, et al. Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev. 2008;29:726–76.

    Article  PubMed  CAS  Google Scholar 

  10. Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr. 2008;88:491S–9S.

    Article  PubMed  CAS  Google Scholar 

  11. Andress DL. Vitamin D in chronic kidney disease: a systemic role for selective vitamin D receptor activation. Kidney Int. 2006;69:33–43.

    Article  PubMed  CAS  Google Scholar 

  12. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest. 2002;110:229–38.

    PubMed  CAS  Google Scholar 

  13. Holick MF. Vitamin D for health and in chronic kidney disease. Semin Dial. 2005;18:266–75.

    Article  PubMed  Google Scholar 

  14. Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab. 2009;94:26–34.

    Article  PubMed  CAS  Google Scholar 

  15. Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington: National Academy of Sciences; 2010.

    Google Scholar 

  16. Heaney RP, Armas LA, Shary JR, Bell NH, Binkley N, Hollis BW. 25-hydroxylation of vitamin D3: relation to circulating vitamin D3 under various input conditions. Am J Clin Nutr. 2008;87:1738–42.

    PubMed  CAS  Google Scholar 

  17. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777–83.

    Article  PubMed  CAS  Google Scholar 

  18. Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. J Bone Miner Res. 2011;26:455–7.

    Article  PubMed  CAS  Google Scholar 

  19. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45:S1-153.

    Google Scholar 

  20. Bener A, Alsaied A, Al-Ali M, et al. High prevalence of vitamin D deficiency in type 1 diabetes mellitus and healthy children. Acta Diabetol. 2009;46:183–9.

    Article  PubMed  CAS  Google Scholar 

  21. Belostotsky V, Mughal Z, Webb NJ. A single high dose of ergocalciferol can be used to boost 25-hydroxyvitamin D levels in children with kidney disease. Pediatr Nephrol. 2009;24:625–6.

    Article  PubMed  Google Scholar 

  22. Hari P, Gupta N, Hari S, Gulati A, Mahajan P, Bagga A. Vitamin D insufficiency and effect of cholecalciferol in children with chronic kidney disease. Pediatr Nephrol. 2010;25:2483–8.

    Article  PubMed  Google Scholar 

  23. Menon S, Valentini RP, Hidalgo G, Peschansky L, Mattoo TK. Vitamin D insufficiency and hyperparathyroidism in children with chronic kidney disease. Pediatr Nephrol. 2008;23:1831–6.

    Article  PubMed  Google Scholar 

  24. Seeherunvong W, Abitbol CL, Chandar J, Zilleruelo G, Freundlich M. Vitamin D insufficiency and deficiency in children with early chronic kidney disease. J Pediatr.2009 ;154:906–11. e1.

    Google Scholar 

  25. Kalkwarf HJ, Denburg MR, Strife CF, et al. Vitamin D deficiency is common in children and adolescents with chronic kidney disease. Kidney Int. 2012;81:690–7.

    Article  PubMed  CAS  Google Scholar 

  26. Andress DL. Bone and mineral guidelines for patients with chronic kidney disease: a call for revision. Clin J Am Soc Nephrol. 2008;3:179–83.

    Article  PubMed  CAS  Google Scholar 

  27. Hollis BW, Jacob Al, Sallman A, Santiz Z, Lambert PW. Circulating vitamin D and its photoproduction in uremia. In: Norman AW, Schaefer K, Herrath Dv, Grigoleit H,eds. Vitamin D, chemical, biochemical and clinical endocrinology of calcium metabolism. Berlin: Walter de Gruyter; 1982.pp.1157-61.

  28. Sato KA, Gray RW, Lemann Jr J. Urinary excretion of 25-hydroxyvitamin D in health and the nephrotic syndrome. J Lab Clin Med. 1982;99:325–30.

    PubMed  CAS  Google Scholar 

  29. Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71:31–8.

    Article  PubMed  CAS  Google Scholar 

  30. Clements MR, Johnson L, Fraser DR. A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature. 1987;325:62–5.

    Article  PubMed  CAS  Google Scholar 

  31. Gutierrez O, Isakova T, Rhee E, et al. Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol. 2005;16:2205–15.

    Article  PubMed  CAS  Google Scholar 

  32. Halloran BP, Schaefer P, Lifschitz M, Levens M, Goldsmith RS. Plasma vitamin D metabolite concentrations in chronic renal failure: effect of oral administration of 25-hydroxyvitamin D3. J Clin Endocrinol Metab. 1984;59:1063–9.

    Article  PubMed  CAS  Google Scholar 

  33. Nykjaer A, Dragun D, Walther D, et al. An endocytic pathway essential for renal uptake and activation of the steroid 25-(OH) vitamin D3. Cell. 1999;96:507–15.

    Article  PubMed  CAS  Google Scholar 

  34. Valdivielso JM. The physiology of vitamin D receptor activation. Contrib Nephrol. 2009;163:206–12.

    Article  PubMed  CAS  Google Scholar 

  35. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl.2009;113:S1-130.

    Google Scholar 

  36. Uhlig K, Berns JS, Kestenbaum B, et al. KDOQI US commentary on the 2009 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of CKD-Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis. 2010;55:773–99.

    Article  PubMed  Google Scholar 

  37. Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metabol. 2008;93:677–81.

    Article  CAS  Google Scholar 

  38. Heaney RP, Recker RR, Grote J, Horst RL, Armas LA. Vitamin D(3) is more potent than vitamin D(2) in humans. J Clin Endocrinol Metabol. 2011;96:E447–52.

    Article  CAS  Google Scholar 

  39. Shroff R, Wan M, Gullett A, et al. Ergocalciferol supplementation in children with CKD delays the onset of secondary hyperparathyroidism: a randomized trial. Clin J Am Soc Nephrol. 2012;7:216–23.

    Article  PubMed  CAS  Google Scholar 

  40. Schmitt CP, Obry J, Feneberg R, et al. Beta1-adrenergic blockade augments pulsatile PTH secretion in humans. J Am Soc Nephrol. 2003;14:3245–50.

    Article  PubMed  CAS  Google Scholar 

  41. Waller SC, Ridout D, Cantor T, Rees L. Parathyroid hormone and growth in children with chronic renal failure. Kidney Int. 2005;67:2338–45.

    Article  PubMed  CAS  Google Scholar 

  42. Wesseling-Perry K, Pereira RC, Sahney S, et al. Calcitriol and doxercalciferol are equivalent in controlling bone turnover, suppressing parathyroid hormone, and increasing fibroblast growth factor-23 in secondary hyperparathyroidism. Kidney Int. 2011;79:112–9.

    Article  PubMed  CAS  Google Scholar 

  43. Greenbaum LA, Benador N, Goldstein SL, et al. Intravenous paricalcitol for treatment of secondary hyperparathyroidism in children on hemodialysis. Am J Kidney Dis. 2007;49:814–23.

    Article  PubMed  CAS  Google Scholar 

  44. Seeherunvong W, Nwobi O, Abitbol CL, Chandar J, Strauss J, Zilleruelo G. Paricalcitol versus calcitriol treatment for hyperparathyroidism in pediatric hemodialysis patients. Pediatr Nephrol. 2006;21:1434–9.

    Article  PubMed  Google Scholar 

  45. Shroff R, Egerton M, Bridel M, et al. A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol. 2008;19:1239–46.

    Article  PubMed  CAS  Google Scholar 

  46. Langman CB, Mazur AT, Baron R, Norman ME. 25-hydroxyvitamin D3 (calcifediol) therapy of juvenile renal osteodystrophy: beneficial effect on linear growth velocity. J Pediatr. 1982;100:815–20.

    Article  PubMed  CAS  Google Scholar 

  47. Chesney RW, Moorthy AV, Eisman JA, Jax DK, Mazess RB, DeLuca HF. Increased growth after long-term oral 1alpha,25-vitamin D3 in childhood renal osteodystrophy. N Engl J Med. 1978;298:238–42.

    Article  PubMed  CAS  Google Scholar 

  48. Chan JC, McEnery PT, Chinchilli VM, et al. A prospective, double-blind study of growth failure in children with chronic renal insufficiency and the effectiveness of treatment with calcitriol versus dihydrotachysterol. The growth failure in children with renal diseases investigators. J Pediatr. 1994;124:520–8.

    Article  PubMed  CAS  Google Scholar 

  49. Mizobuchi M, Morrissey J, Finch JL, et al. Combination therapy with an angiotensin-converting enzyme inhibitor and a vitamin D analog suppresses the progression of renal insufficiency in uremic rats. J Am Soc Nephrol. 2007;18:1796–806.

    Article  PubMed  CAS  Google Scholar 

  50. Fishbane S, Chittineni H, Packman M, Dutka P, Ali N, Durie N. Oral paricalcitol in the treatment of patients with CKD and proteinuria: a randomized trial. Am J Kidney Dis. 2009;54:647–52.

    Article  PubMed  CAS  Google Scholar 

  51. Alborzi P, Patel NA, Peterson C, et al. Paricalcitol reduces albuminuria and inflammation in chronic kidney disease: a randomized double-blind pilot trial. Hypertension. 2008;52:249–55.

    Article  PubMed  CAS  Google Scholar 

  52. Agarwal R, Acharya M, Tian J, et al. Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney Int. 2005;68:2823–8.

    Article  PubMed  CAS  Google Scholar 

  53. de Zeeuw D, Agarwal R, Amdahl M, et al. Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. Lancet. 2010;376:1543–51.

    Article  PubMed  Google Scholar 

  54. Feneis JF, Arora RR. Role of vitamin D in blood pressure homeostasis. Am J Ther. 2010;17:e221–9.

    Article  PubMed  Google Scholar 

  55. Mak RH. Amelioration of hypertension and insulin resistance by 1,25-dihydroxycholecalciferol in hemodialysis patients. Pediatr Nephrol. 1992;6:345–8.

    Article  PubMed  CAS  Google Scholar 

  56. Wolf M, Shah A, Gutierrez O, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int. 2007;72:1004–13.

    Article  PubMed  CAS  Google Scholar 

  57. Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168:1340–9.

    Article  PubMed  CAS  Google Scholar 

  58. Melamed ML, Astor B, Michos ED, Hostetter TH, Powe NR, Muntner P. 25-hydroxyvitamin D levels, race, and the progression of kidney disease. J Am Soc Nephrol. 2009;20:2631–9.

    Article  PubMed  CAS  Google Scholar 

  59. Ravani P, Malberti F, Tripepi G, et al. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int. 2009;75:88–95.

    Article  PubMed  CAS  Google Scholar 

  60. Kovesdy CP, Ahmadzadeh S, Anderson JE, Kalantar-Zadeh K. Association of activated vitamin D treatment and mortality in chronic kidney disease. Arch Intern Med. 2008;168:397–403.

    Article  PubMed  CAS  Google Scholar 

  61. Wolf M, Betancourt J, Chang Y, et al. Impact of activated vitamin D and race on survival among hemodialysis patients. J Am Soc Nephrol. 2008;19:1379–88.

    Article  PubMed  CAS  Google Scholar 

  62. Teng M, Wolf M, Ofsthun MN, et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol. 2005;16:1115–25.

    Article  PubMed  CAS  Google Scholar 

  63. Mathew S, Lund RJ, Chaudhary LR, Geurs T, Hruska KA. Vitamin D receptor activators can protect against vascular calcification. J Am Soc Nephrol. 2008;19:1509–19.

    Article  PubMed  CAS  Google Scholar 

  64. Bodyak N, Ayus JC, Achinger S, et al. Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals. Proc Natl Acad Sci USA. 2007;104:16810–5.

    Article  PubMed  CAS  Google Scholar 

  65. Patange AR, Valentini RP, Du W, Pettersen MD. Vitamin d deficiency and arterial wall stiffness in children with chronic kidney disease. Pediatr Cardiol. 2012;33:122–8.

    Article  PubMed  Google Scholar 

  66. Tan X, Wen X, Liu Y. Paricalcitol inhibits renal inflammation by promoting vitamin D receptor-mediated sequestration of NF-kappaB signaling. J Am Soc Nephrol. 2008;19:1741–52.

    Article  PubMed  CAS  Google Scholar 

  67. Tan X, He W, Liu Y. Combination therapy with paricalcitol and trandolapril reduces renal fibrosis in obstructive nephropathy. Kidney Int. 2009;76:1248–57.

    Article  PubMed  CAS  Google Scholar 

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Role of Funding Source

Dr. Kumar is supported by a K 23 grant, DK084339 from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

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Correspondence to Juhi Kumar.

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Chau, YY., Kumar, J. Vitamin D in Chronic Kidney Disease. Indian J Pediatr 79, 1062–1068 (2012). https://doi.org/10.1007/s12098-012-0765-1

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