Vitamin D in Chronic Kidney Disease by Pablo A. Ureña Torres Mario Cozzolino & Marc G. Vervloet

Author:Pablo A. Ureña Torres, Mario Cozzolino & Marc G. Vervloet
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Although the close relationship between vitamin D and kidney seems to have even greater importance, as it is known to activate VDR and can reduce proteinuria and contribute to nephroprotection [21]. Experimental models have shown the effect of vitamin D on the blockade of the renin-angiotensin-aldosterone system (RAAS), protection of podocytes and mesangial cells, inflammation and tubulointerstitial fibrosis [22].

Albuminuria is a typical finding in patients with diabetic nephropathy (DN). Evidence from clinical trials and associated data from the NHANES III cohort demonstrated an inverse relationship between 25(OH)D levels and degree of albuminuria. Furthermore, diabetes is closely associated with low 25(OH)D levels. Given the above findings, patients with established DN are expected to have even lower 25(OH)D levels than patients with CKD from other causes but a similar estimated glomerular filtration rate (eGFR). In fact, the prevalence of 25(OH)D insufficiency (93 %) and deficiency (51.5 %) was high in CKD patients with and without diabetes.

Several clinical studies in patients with proteinuric nephropathy have analyzed the activation role of VDR in relation the decrease in proteinuria, progression of renal disease, and mortality, some in diabetic nephropathy. The study that has had the most profound impact is the VITAL study in patients with type-2 diabetes and renal failure with albuminuria in stages 2–4. This was a double blind, randomized, case-control study using 2 mg of paricalcitol, a specific activator of VDR, in combination with an inhibitor of RAAS. The findings showed a greater decrease in proteinuria, better control of blood pressure, and a decrease in the progression of kidney failure. Proteinuria predicts the occurrence of cardiovascular events, mortality, and hospital admissions, though there is also a deteriorating relationship between proteinuria and glomerular filtration. Studies have shown that vitamin D has a renoprotective effect in patients with diabetes mellitus, possibly due to the reduction in proteinuria, a reduction of the activity of the renin-angiotensin system, or due to direct renal effects [22]. However, a recent meta-analysis that included 18 studies of treatment with vitamin D observed a reduction in proteinuria but without modification on renal function.

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