Vitamin D – current overview of the issue and specifics in nephrological practice
Authors:
Sulková Dusilová Sylvie 1; Šafránek Roman 1; Pavlíková Ladislava 2; Pokorná Anita 1; Kadlec Mirko 1; Hudík Filip 1; Horáček Jiří 3; Hyšpler Radomír 2; Palička Vladimír 2
Authors‘ workplace:
Nefrologická klinika, FN Hradec Králové a LF UK v Hradci Králové
1; Ústav klinické biochemie a diagnostiky, FN Hradec Králové a LF UK v Hradci Králové
2; IV. interní hematologická klinika, FN Hradec Králové a LF UK v Hradci Králové
3
Published in:
Clinical Osteology 2025; 30(1): 22-29
Category:
Overview
Recent randomized placebo-controlled trials did not demonstrate clear clinical benefits of nutritional vitamin D supplementation in non-selected population. Therefore, current recommendations suggest testing vitamin D serum values only in vitamin D deficiency risk groups of patients. Kidney disease patients are at this risk.
Target serum calcidiol (25-hydroxyvitamin D) concentrations in kidney disease or failure and also in kidney transplant patients should be higher than 75 nmol/l. The reason for this target is to maintain sufficient calcitriol to suppress early parathyroid gland overactivity. On the contrary, calcidiol values over 50 nmol/l are acceptable in general population.
In healthy people, the renal calcidiol hydroxylation to calcitriol (i. e. active vitamin D) is not complicated. However, in chronic kidney disease, the renal calcitriol production is decreased. This decrease is dependent not only on the diminished renal function, but also on complicated regulatory mechanisms. In kidney failure, the extrarenal calcitriol production is more important than previously thought. However, the extrarenal 1-alpha-hydroxylase is active only if serum calcidiol values are sufficient.
Nutritional vitamin D supplementation is important to correct vitamin D deficiency in all kidney patients regardless on their renal function. Suppressive therapy with calcitriol or its analogues blocks directly parathormone production in parathyroid glands. Both nutritional and suppressive therapies can be combined, as needed. The novel approach is synthetic (pharmaceutically produced) calcidiol.
The paper deals with vitamin D and brings novel information, with the main aim to compare vitamin D metabolism and treatment between general population and nephrology patients.
Keywords:
vitamin D, cholecalciferol, calcitriol, vitamin D supplementation, chronic kidney disease, parathyroid gland suppression, vitamin D deficiency, paricalcitol.
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Clinical Osteology
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