Kidney failure and vitamin D deficiency vicious cycle

Defective renal maintenance of the vitamin D endocrine system impairs vitamin D renoprotection: a downward spiral in kidney disease.

Kidney Int. 2011 Jan 26.

Dusso AS, [email protected]; Tokumoto M.

1] Renal Division, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA ^[2] Experimental Nephrology Laboratory, IRB Lleida, Lleida, Spain.

In kidney disease, the progressive loss of renal capacity to produce calcitriol, the vitamin D hormone, is a key contributor to elevations in parathyroid hormone (PTH) and mineral and skeletal disorders predisposing to renal and cardiovascular damage, ectopic calcifications, and high mortality rates. Thus, the safe correction of calcitriol deficiency to suppress PTH has been the treatment of choice for decades. However, recent epidemiological and experimental data suggest that calcitriol replacement may improve outcomes through renal and cardioprotective actions unrelated to PTH suppression. Furthermore, a striking incidence of vitamin D deficiency occurs in kidney disease and associates more strongly than calcitriol deficiency with a higher risk for kidney disease progression and death. Despite the translational relevance of these findings, no prospective trials are currently available in support of the efficacy of vitamin D supplementation and/or calcitriol replacement to safely halt/moderate renal disease progression.

This review updates the pathophysiology behind the vicious cycle by which kidney injury impairs the maintenance of normal vitamin D and calcitriol levels, which in turn impedes vitamin D/calcitriol renoprotective actions, a requirement for the design of prospective trials to improve current recommendations for vitamin D interventions at all stages of kidney disease.

Kidney International advance online publication, 26 January 2011; doi:10.1038/ki.2010.543. PMID: 21270766

CLICK HERE to see author's 52 other publications which concern vitamin D

See also in Vitamin D Life

• All Kidney and Vitamin D items in Vitamin D Life items

• Overview Kidney and vitamin D has excellent graphs

• Seniors with poorly functioning kidneys had lower levels of vitamin D – Feb 2012

• Application to FDA for use of active Vitamin D for hemodialysis patients – July 2011

• Dialysis patients with low vitamin D were 2.7 X more likely to die of heart problems – Feb 2011

• Virtually all black dialysis patients with low albumin are vitamin D deficient in the winter – Mar 2010

• Low vitamin D associated with hemodialysis problems – May 2010

• Kidney failure and vitamin D deficiency vicious cycle – Jan 2011

• Vitamin D receptor activation and Chronic Kidney Disease – Oct 2011

• Each 10 ng increase in vitamin D decreased kidney disease death by 14 percent – May 2011 Meta-analysis

• Dusso 2005 paper on Vitamin D is attached to the bottom of this page

• Possible Vitamin D interactions and vicious circles which has the following chart