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J Cachexia Sarcopenia Muscle. 2017 Oct;8(5):686-701. doi: 10.1002/jcsm.12218. Epub 2017 Jul 3.

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease.

Author information

1
Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain.
2
REDinREN, Madrid, Spain.
3
Department of Medicine, Universitat de València, Valencia, Spain.
4
Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
5
Department of Nephrology, Fundació Puigvert, Barcelona, Spain.
6
IIB Sant Pau, Barcelona, Spain.
7
Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux et Aurad-Aquitaine, Bordeaux, France.
8
Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
9
Department of Nephrology and Dialysis, Clinique du Landy, Ramsay-Générale de Santé, Saint Ouen, Paris, France.
10
Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France.

Abstract

The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non-genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25-hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

KEYWORDS:

Bone; Chronic kidney disease; Muscle; Physical performance; Vitamin D

PMID:
28675610
PMCID:
PMC5659055
DOI:
10.1002/jcsm.12218
[Indexed for MEDLINE]
Free PMC Article

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