[Chronic kidney disease (CKD) and bone. Pleiotropic actions of vitamin D and survival advantage]

In addition to its actions on bone and mineral metabolism, vitamin D plays various roles in diverse systems. Vitamin D suppresses the renin-angiotensin system, increases insulin secretion and sensitivity, protects against cardiac hypertrophy, and increases left ventricular contraction. Also, vitamin D has anti-atherogenic and anti-inflammatory activities. Observational cohort studies in dialysis and predialysis patients with chronic renal failure show that vitamin D users, as compared to non-users, have better survival rate. Furthermore, the use of active vitamin D is associated with decreased proteinuria and a lower risk for developing end-stage renal disease. Further evidence is needed to establish these pleiotropic actions of vitamin D.