Vitamin D Effects on Bone Homeostasis and Cardiovascular System in Patients with Chronic Kidney Disease and Renal Transplant Recipients

• Published in: Nutrients 2021-04, Vol.13 (5), p.1453
• Main Authors: Cianciolo, Giuseppe, Cappuccilli, Maria, Tondolo, Francesco, Gasperoni, Lorenzo, Zappulo, Fulvia, Barbuto, Simona, Iacovella, Francesca, Conte, Diletta, Capelli, Irene, La Manna, Gaetano
• Format: Article
• Language: English
• Subjects: Alfacalcidol; Bone and Bones - drug effects; Bone turnover; Bones; Calcifediol; Calciferol; Calcification; Cardiovascular disease; cardiovascular risk; Cardiovascular system; Cardiovascular System - drug effects; Care and treatment; chronic kidney disease; Chronic kidney failure; CKD–MBD; Cytochrome; Dialysis; Dietary restrictions; Fractures; Gene expression; Health aspects; Homeostasis; Homeostasis - drug effects; Hormones; Humans; Hydroxylation; Immune response; Immunomodulation; Kidney diseases; kidney transplant; Kidney Transplantation; Kidney transplants; Kidneys; Low protein diet; Malnutrition; Metabolism; Mineralization; Nutrient deficiency; Organ transplant recipients; Phosphates; Proteins; Proteinuria; Renal function; Renal Insufficiency, Chronic - physiopathology; Review; Transplant Recipients; Uremia; Vitamin D; Vitamin D - administration & dosage; Vitamin D - pharmacology; Vitamin D Deficiency - prevention & control; Vitamin deficiency; Vitamins - administration & dosage; Vitamins - pharmacology
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu13051453

Poor vitamin D status is common in patients with impaired renal function and represents one main component of the complex scenario of chronic kidney disease-mineral and bone disorder (CKD-MBD). Therapeutic and dietary efforts to limit the consequences of uremia-associated vitamin D deficiency are a current hot topic for researchers and clinicians in the nephrology area. Evidence indicates that the low levels of vitamin D in patients with CKD stage above 4 (GFR < 15 mL/min) have a multifactorial origin, mainly related to uremic malnutrition, namely impaired gastrointestinal absorption, dietary restrictions (low-protein and low-phosphate diets), and proteinuria. This condition is further worsened by the compromised response of CKD patients to high-dose cholecalciferol supplementation due to the defective activation of renal hydroxylation of vitamin D. Currently, the literature lacks large and interventional studies on the so-called non-calcemic activities of vitamin D and, above all, the modulation of renal and cardiovascular functions and immune response. Here, we review the current state of the art of the benefits of supplementation with native vitamin D in various clinical settings of nephrological interest: CKD, dialysis, and renal transplant, with a special focus on the effects on bone homeostasis and cardiovascular outcomes.