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Vitamin D and Progression of Renal Failure

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Vitamin D in Chronic Kidney Disease

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Abstract

In addition to his widely recognized endocrine effects on the calcium, phosphate, PTH metabolism, vitamin D has many other pleiotropic effects on the vascular function, blood pressure, proteinuria, insulin resistance, lipid metabolism, inflammation, immunity which all may play a role in the progression of renal failure. Angiotensin-converting enzyme inhibitors (ACEi) for renin-angiotensin-aldosterone system (RAAS) blockade are routinely used to slow CKD progression. Natural vitamin D and active vitamin D analogs may further reduce proteinuria in CKD patients in addition to these current treatment regimens. The inverse correlation of blood pressure and vitamin D plasma levels as well as promising data from small intervention studies of vitamin D supplementation provide a rationale for well performed RCT addressing efficacy and safety of vitamin D in hypertension/cardiovascular diseases. Unfortunately, up to now three RCT have not been able to support this.

Determination of the optimal vitamin D analogue and its optimal dosage in case of protection or slowing down the development of vascular calcifications remains to be investigated in depth in pre-clinical and clinical conditions. Vitamin D supplementation may lead to a small but significant improvement in mortality but did not appear to prevent the development of diabetes in the largest clinical trial to date.

Effects of Vitamin D on renal fibrosis and slowing down/preventing progressive renal damage has been investigated thoroughly in vitro, in vivo and in humans but currently limited to a promising item. The increase in serum creatinine observed during several studies is not attributable to a decrease of the glomerular filtration rate but on the increased creatinine generation, an anabolic effect of vitamin D. Natural vitamin D and active vitamin D preparations are among the few reasonable and evident candidates to be tested in a multicenter, prospective RCT as a potential protector of the failing kidney in patients with CKD 3 and 4.

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Acknowledgement

Erik Snelders was a more than relevant help in the realization of this manuscript.

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  1. University Antwerpen, Antwerp, Belgium

    Marc De Broe MD, PhD

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  1. Ramsay-Générale de Santé, Clinique du Landy, Saint Ouen, France

    Pablo A. Ureña Torres

  2. San Paolo Hospital, DiSS University of Milan, Milan, Italy

    Mario Cozzolino

  3. VU University Medical Center, Amsterdam, The Netherlands

    Marc G. Vervloet

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De Broe, M. (2016). Vitamin D and Progression of Renal Failure. In: Ureña Torres, P., Cozzolino, M., Vervloet, M. (eds) Vitamin D in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-32507-1_14

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