Vitamin D and Parathyroid Hormone in Kidney Disease
Chronic kidney disease (CKD) is a modern-day epidemic with significant morbidity and mortality. It is well known that CKD is accompanied by reduced conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D and by deficiency of 25-hydroxyvitamin D. These metabolic changes combined with hypocalcemia and hyperphosphatemia lead to secondary hyperparathyroidism, renal osteodystrophy, and vascular calcification. Attempts to prevent this disorder have led to the widespread use of vitamin D receptor agonists and nutritional vitamin D. This is particularly enhanced by the observational data that support the notion that vitamin D treatment may influence survival especially in patients with end-stage renal disease. Furthermore, calcimimetic agents have demonstrated efficacy for reducing parathyroid hormone (PTH) levels without the risk of hypercalcemia or hyperphosphatemia. In this chapter, we discuss the roles of vitamin D and PTH in the CKD population and outline the current state of evidence supporting their therapeutic use.
KeywordsCalcitriol Chronic kidney disease End-stage renal disease Randomized controlled trials Vitamin D-binding protein
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