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Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcom...

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Published in:Nutrients 2023-03, Vol.15 (7), p.1576
Main Authors: Bover, Jordi, Massó, Elisabet, Gifre, Laia, Alfieri, Carlo, Soler-Majoral, Jordi, Fusaro, Maria, Calabia, Jordi, Rodríguez-Pena, Rosely, Rodríguez-Chitiva, Néstor, López-Báez, Víctor, Sánchez-Baya, Maya, da Silva, Iara, Aguilar, Armando, Bustos, Misael C, Rodrigues, Natacha, Chávez-Iñiguez, Jonathan S, Romero-González, Gregorio, Valdivielso, José Manuel, Molina, Pablo, Górriz, José L
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cited_by cdi_FETCH-LOGICAL-c540t-bbdce579be6e8cc49cacff8d5443a6d62a7688e52c36bccd79c9f813b7f7c8973
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container_issue 7
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container_title Nutrients
container_volume 15
creator Bover, Jordi
Massó, Elisabet
Gifre, Laia
Alfieri, Carlo
Soler-Majoral, Jordi
Fusaro, Maria
Calabia, Jordi
Rodríguez-Pena, Rosely
Rodríguez-Chitiva, Néstor
López-Báez, Víctor
Sánchez-Baya, Maya
da Silva, Iara
Aguilar, Armando
Bustos, Misael C
Rodrigues, Natacha
Chávez-Iñiguez, Jonathan S
Romero-González, Gregorio
Valdivielso, José Manuel
Molina, Pablo
Górriz, José L
description Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.
doi_str_mv 10.3390/nu15071576
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L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines</atitle><jtitle>Nutrients</jtitle><addtitle>Nutrients</addtitle><date>2023-03-24</date><risdate>2023</risdate><volume>15</volume><issue>7</issue><spage>1576</spage><pages>1576-</pages><issn>2072-6643</issn><eissn>2072-6643</eissn><abstract>Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>37049415</pmid><doi>10.3390/nu15071576</doi><orcidid>https://orcid.org/0000-0003-4994-6238</orcidid><orcidid>https://orcid.org/0009-0008-4871-4447</orcidid><orcidid>https://orcid.org/0000-0001-5855-8494</orcidid><orcidid>https://orcid.org/0000-0002-2535-0205</orcidid><orcidid>https://orcid.org/0000-0003-1343-0184</orcidid><orcidid>https://orcid.org/0000-0001-9478-4851</orcidid><orcidid>https://orcid.org/0000-0003-3860-5219</orcidid><orcidid>https://orcid.org/0000-0003-2786-6667</orcidid><orcidid>https://orcid.org/0000-0001-6806-9539</orcidid><orcidid>https://orcid.org/0000-0003-3577-2273</orcidid><orcidid>https://orcid.org/0000-0002-8311-6214</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 2072-6643
ispartof Nutrients, 2023-03, Vol.15 (7), p.1576
issn 2072-6643
2072-6643
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_23a35e3f57a74d8ea5fe97c0b2c3c6ae
source Publicly Available Content Database; PubMed Central
subjects Alfacalcidol
Bone Diseases
calcidiol
Calcifediol
Calciferol
calcitriol
Cardiovascular disease
Cardiovascular diseases
chronic kidney disease
Chronic kidney failure
CKD-MBD
Clinical trials
Complications and side effects
Diet therapy
Dietary supplements
Endocrinology
Enzymes
Fractures
Guidelines
Health aspects
Humans
Hyperparathyroidism
Hyperparathyroidism, Secondary - complications
Hyperparathyroidism, Secondary - etiology
Kidney
Kidney diseases
Kidneys
Metabolism
Minerals
Minerals - therapeutic use
Mortality
Nephrology
Osteoporosis
Parathyroid Hormone
Patients
Prevention
Renal Insufficiency, Chronic - therapy
Review
Risk factors
secondary hyperparathyroidism
Sexually transmitted diseases
STD
Vitamin D
Vitamin D - therapeutic use
Vitamin D deficiency
Vitamin D Deficiency - complications
Vitamin D Deficiency - drug therapy
Vitamin deficiency
Vitamins - therapeutic use
title Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines
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