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Am J Kidney Dis. 2018 Dec;72(6):834-845. doi: 10.1053/j.ajkd.2018.06.031. Epub 2018 Oct 5.

The Role of Vitamin D in CKD Stages 3 to 4: Report of a Scientific Workshop Sponsored by the National Kidney Foundation.

Author information

1
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY. Electronic address: michal.melamed@einstein.yu.edu.
2
Univerity of Colorado Denver, Aurora, CO.
3
University of Alabama at Birmingham, Birmingham, AL.
4
University of California-Irvine, Orange.
5
University of California-Los Angeles, Los Angeles, CA.
6
Duke University School of Medicine, Durham, NC.
7
Massachusetts General Hospital, Boston, MA; Cedars-Sinai Medical Center, Los Angeles, CA.

Abstract

Deficiency of 25-hydroxyvitamin D (25[OH]D) is common in patients with chronic kidney disease stages 3 and 4 and is associated with poor outcomes. However, the evaluation and management of vitamin D deficiency in nephrology remains controversial. This article reports on the proceedings from a "controversies conference" on vitamin D in chronic kidney disease that was sponsored by the National Kidney Foundation. The report outlines the deliberations of the 3 work groups that participated in the conference. Until newer measurement methods are widely used, the panel agreed that clinicians should classify 25(OH)D "adequacy" as concentrations > 20ng/mL without evidence of counter-regulatory hormone activity (ie, elevated parathyroid hormone). The panel also agreed that 25(OH)D concentrations < 15ng/mL should be treated irrespective of parathyroid hormone level. Patients with 25(OH)D concentrations between 15 and 20ng/mL may not require treatment if there is no evidence of counter-regulatory hormone activity. The panel agreed that nutritional vitamin D (cholecalciferol, ergocalciferol, or calcifediol) should be supplemented before giving activated vitamin D compounds. The compounds need further study evaluating important outcomes that observational studies have linked to low 25(OH)D levels, such as progression to end-stage kidney disease, infections, fracture rates, hospitalizations, and all-cause mortality. We urge further research funding in this field.

KEYWORDS:

24;25-dihydroxyvitamin D (24;25[OH](2)D); 25-hydroxyvitamin D (25[OH]D); Vitamin D; chronic kidney disease (CKD); mineral and bone disorder (MBD); racial differences; renal osteodystrophy; secondary hyperparathyroidism (SHPT); vitamin D deficiency; vitamin D metabolite ratio (VMR); vitamin D repletion

PMID:
30297082
PMCID:
PMC6615058
[Available on 2019-12-01]
DOI:
10.1053/j.ajkd.2018.06.031
[Indexed for MEDLINE]

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