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

2 Citations (Scopus)

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)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Vitamin D
Parathyroid Hormone
Chronic Renal Insufficiency
Kidney
Education
Hormones
Ergocalciferols
Calcifediol
Vitamin D Deficiency
Nephrology
Cholecalciferol
Chronic Kidney Failure
Observational Studies
Hospitalization
Outcome Assessment (Health Care)
Mortality
Infection
Research
Therapeutics
25-hydroxyvitamin D

Keywords

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

ASJC Scopus subject areas

  • Nephrology

Cite this

The Role of Vitamin D in CKD Stages 3 to 4 : Report of a Scientific Workshop Sponsored by the National Kidney Foundation. / Melamed, Michal L.; Chonchol, Michel; Gutiérrez, Orlando M.; Kalantar-Zadeh, Kamyar; Kendrick, Jessica; Norris, Keith; Scialla, Julia J.; Thadhani, Ravi.

In: American Journal of Kidney Diseases, 01.01.2018.

Research output: Contribution to journalArticle

Melamed, Michal L. ; Chonchol, Michel ; Gutiérrez, Orlando M. ; Kalantar-Zadeh, Kamyar ; Kendrick, Jessica ; Norris, Keith ; Scialla, Julia J. ; Thadhani, Ravi. / The Role of Vitamin D in CKD Stages 3 to 4 : Report of a Scientific Workshop Sponsored by the National Kidney Foundation. In: American Journal of Kidney Diseases. 2018.
@article{c593fbec744b478da163e9bdb3192dcd,
title = "The Role of Vitamin D in CKD Stages 3 to 4: Report of a Scientific Workshop Sponsored by the National Kidney Foundation",
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.",
keywords = "24;25-dihydroxyvitamin D (24;25[OH]D), 25-hydroxyvitamin D (25[OH]D), chronic kidney disease (CKD), mineral and bone disorder (MBD), racial differences, renal osteodystrophy, secondary hyperparathyroidism (SHPT), Vitamin D, vitamin D deficiency, vitamin D metabolite ratio (VMR), vitamin D repletion",
author = "Melamed, {Michal L.} and Michel Chonchol and Guti{\'e}rrez, {Orlando M.} and Kamyar Kalantar-Zadeh and Jessica Kendrick and Keith Norris and Scialla, {Julia J.} and Ravi Thadhani",
year = "2018",
month = "1",
day = "1",
doi = "10.1053/j.ajkd.2018.06.031",
language = "English (US)",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - The Role of Vitamin D in CKD Stages 3 to 4

T2 - Report of a Scientific Workshop Sponsored by the National Kidney Foundation

AU - Melamed, Michal L.

AU - Chonchol, Michel

AU - Gutiérrez, Orlando M.

AU - Kalantar-Zadeh, Kamyar

AU - Kendrick, Jessica

AU - Norris, Keith

AU - Scialla, Julia J.

AU - Thadhani, Ravi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - 24;25-dihydroxyvitamin D (24;25[OH]D)

KW - 25-hydroxyvitamin D (25[OH]D)

KW - chronic kidney disease (CKD)

KW - mineral and bone disorder (MBD)

KW - racial differences

KW - renal osteodystrophy

KW - secondary hyperparathyroidism (SHPT)

KW - Vitamin D

KW - vitamin D deficiency

KW - vitamin D metabolite ratio (VMR)

KW - vitamin D repletion

UR - http://www.scopus.com/inward/record.url?scp=85054525723&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054525723&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2018.06.031

DO - 10.1053/j.ajkd.2018.06.031

M3 - Article

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

ER -