The Role of Vitamin D in CKD Stages 3 to 4: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

Michal L. Melamed, Michel Chonchol, Orlando M. Gutiérrez, Kamyar Kalantar-Zadeh, Jessica Kendrick, Keith Norris, Julia J. Scialla, Ravi Thadhani

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

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 > 20 ng/mL without evidence of counter-regulatory hormone activity (ie, elevated parathyroid hormone). The panel also agreed that 25(OH)D concentrations < 15 ng/mL should be treated irrespective of parathyroid hormone level. Patients with 25(OH)D concentrations between 15 and 20 ng/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.

Original languageEnglish (US)
Pages (from-to)834-845
Number of pages12
JournalAmerican Journal of Kidney Diseases
Volume72
Issue number6
DOIs
StatePublished - Dec 2018

Keywords

  • 24;25-dihydroxyvitamin D (24;25[OH]D)
  • 25-hydroxyvitamin D (25[OH]D)
  • Vitamin D
  • chronic kidney disease (CKD)
  • mineral and bone disorder (MBD)
  • racial differences
  • renal osteodystrophy
  • secondary hyperparathyroidism (SHPT)
  • vitamin D deficiency
  • vitamin D metabolite ratio (VMR)
  • vitamin D repletion

ASJC Scopus subject areas

  • Nephrology

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  • Cite this

    Melamed, M. L., Chonchol, M., Gutiérrez, O. M., Kalantar-Zadeh, K., Kendrick, J., Norris, K., Scialla, J. J., & Thadhani, R. (2018). The Role of Vitamin D in CKD Stages 3 to 4: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. American Journal of Kidney Diseases, 72(6), 834-845. https://doi.org/10.1053/j.ajkd.2018.06.031