The KDOQI has now started recommending that we check inactivated Vitamin D levels in all CKD patients with hyperparathyrodism and if the level is <30, to start replacing them with either D2 50,000 units once a week for 3 months or D3 1000 units once a day for 3 months. This is the nutritional deficiency recommendation based on the general population. There have been many studies in the general population with effects on even none bone/muscle organs: cancer prevention, decreased renin, decreased cardiac disease and so forth.
1. What are the implications of this in CKD and ESRD population?
2. Does it matter to replace inactivated vitamin D in ESRD patients?
3. Won't the inactivated D be more suppressed in our ESRD patients since we are giving them activated Vitamin D, sometimes in excess?
A recent study showed that lower levels of the inactivated Vitamin D was associated with increased mortality in HD patients but the administration of activated vitamin D to these patients decreased the mortality.
There is one study by Bert et al, that found that vitamin D3 was not as effective as activated vitamin D in decreasing pth levels in dialysis patients. Bone biopsies actually showed worsening of disease.
There is 1 alpha hydroxylation happening else where, mainly macrophages and other cells besides the kidney. Giving 25-OH might activated those cells to convert more and we can get extra renal activations.
But again, data is observational and there is no harm in giving nutritional supplemental vitamin D as long as the calcium and phosphorus are in good range.
The role of a combination of a calcimimetic and 25-0h vitamin D might be interesting to look at according to many experts. Well designed trials comparing both measures of just vitamin D alone vs vitamin D + calcimimetic vs activated vitamin D alone might be worth looking at.
Look at the below references
The first one is a nice review on all bone diseases in CKD( a nice table is in the article that summarizes a lot), good board prep table.
Kalantar-Zadeh K, Shah A, Duong U, Hechter RC, Dukkipati R, Kovesdy CP. Kidney Bone Disease and Mortality in CKD: Revisiting the role of Vitamin D, calcimimetics, alkaline phosphatase, and minerals. Kidney Int 2010:78 (suppl 117):S10-S21.
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- Educational Video
- CMV infection in Kidney Transplantation
- The Online Transplant Center: CMV infection in Kid...
- Early Dialysis
- Polycystic Kidney Disease
- IN THE NEWS: LIVER induced erythropoietin producti...
- JOURNAL CLUB: RITUXIVAS Trial
- Interferon Gamma use in fungal infections in trans...
- DIURETICS PRESENTATION
- IN THE NEWS- Hyperkalemia review
- Quiz 4 Answers
- The Kidney is not silent
- CLINICAL CASE 24, ANSWERS and SUMMARY
- The Online Transplant Center
- Post Transplant Lymphoproliferative Disorder (PTLD...
- B cell and long term graft function
- Renal Fellow Network: Hot peppers for hypertension...
- CONSULT ROUNDS: LOW POTASSIUM STORY!
- IN THE NEWS: MIDODRINE
- CONSULT ROUNDS: ANCA negative Pauci-Immune Cresent...
- Transplantatation of two kidneys in marginal donor...
- The Micro RNA blog
- History of Nephrology: A nice image of The father ...
- CONSULT ROUNDS: Resp Alkalosis
- BKV viral protein-1 mRNA in urinary cells
- TOPIC DISCUSSION: Plasma Pheresis and Renal Diseas...
- IN THE NEWS: DETECTIVE NEPHRON's NEXT VENTURE
- CLINICAL CASE 23 , ANSWER and SUMMARY
- TOPIC DISCUSSION: Hyperkalemia due to cell shifts?...
- Educational Link on nephrology
- CLINICAL CASE 22, ANSWERS AND SUMMARY
- Medical Innovation
- CONSULT ROUNDS: Management of BEER POTAMANIA
- The Online Transplant Center: Low Donor Kidney Wei...
- Low Donor Kidney Weight ? Does it matter?
- Renal Biopsy simulation
- Reno vascular Hypertension View more presentation...
- Post transplant TMA, revisiting Atypical HUS
- TOPIC DISCUSSION: 25-OH Vitamin D and ESRD
- IN THE NEWS:- MAYO CLINIC AND SOCIAL MEDIA
- ▼ August (40)