Improving survival of dialysis patients with active vitamin D
Cardiovascular disease is the leading cause of death among patients on hemodialysis. Secondary hyperparathyroidism (sHPT), hyperphosphatemia, hypocalcemia and deficiency of calcitriol, the active hormonal form of vitamin, are common complications of chronic kidney disease (CKD) that are associated with cardiovascular disease and mortality on dialysis. Treatment of sHPT using calcitriol or one of its analogs has traditionally focused on protection from bone complications, but several recent observational studies suggest a survival benefit of vitamin D therapy. While these results require verification in randomized trials and the potential biological mechanisms that underlie the benefit of vitamin D on dialysis survival require further study, several clues have recently emerged. Vitamin D exerts a variety of effects on the cardiovascular and immune systems, on inflammation, glucose tolerance, among others such that deficiencies in the vitamin D axis are associated with increased risk of adverse outcomes. Indeed, in recent work from our group, deficiencies in the vitamin D axis were associated with early mortality among incident hemodialysis patients regardless of serum PTH. These results suggest that critical deficiencies in the vitamin D axis are novel risk factors for cardiovascular disease and mortality which might explain why active vitamin D therapy improves survival, similarly independent of PTH levels. © 2008 Dustri-Verlag Dr. Karl Feistle.
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