The Role of Vitamin D in CKD Stages 3 to 4: Report of a Scientific Workshop Sponsored by the National Kidney Foundation.
Journal Article (Journal Article;Review)
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.
Full Text
Duke Authors
Cited Authors
- Melamed, ML; Chonchol, M; Gutiérrez, OM; Kalantar-Zadeh, K; Kendrick, J; Norris, K; Scialla, JJ; Thadhani, R
Published Date
- December 2018
Published In
Volume / Issue
- 72 / 6
Start / End Page
- 834 - 845
PubMed ID
- 30297082
Pubmed Central ID
- PMC6615058
Electronic International Standard Serial Number (EISSN)
- 1523-6838
Digital Object Identifier (DOI)
- 10.1053/j.ajkd.2018.06.031
Language
- eng
Conference Location
- United States