[Vitamin D and kidney diseases]

Area of Science:

• Nephrology
• Endocrinology
• Pharmacology

Context:

• Chronic kidney disease (CKD) is associated with significant renal and cardiovascular complications.
• The renin-angiotensin system and NF-κB activation play critical roles in renal inflammation and fibrogenesis.
• Vitamin D's pleiotropic effects offer potential therapeutic benefits in CKD management.

Purpose:

• To review the multifaceted roles of calcitriol, vitamin D analogs, and native vitamin D in the context of chronic kidney disease.
• To evaluate the safety and efficacy of vitamin D administration in CKD patients, including its impact on mortality, proteinuria, inflammation, and fibrogenesis.
• To explore the potential of vitamin D analogs in renal transplantation.

Summary:

• Calcitriol and its analogs inhibit the renin-angiotensin system and NF-κB activation, mitigating glomerular and tubulo-interstitial damage, and reducing proteinuria in CKD.
• Native vitamin D (cholecalciferol or ergocalciferol) administration in CKD patients reduces parathyroid hormone levels and is associated with reduced mortality, antiproteinuric effects, and anti-inflammatory properties.
• Native vitamin D is safe in CKD patients, without increased risk of vascular calcification or renal stones, even at pharmacological doses when not combined with calcium salts.

Impact:

• Vitamin D supplementation represents a safe and effective strategy to manage CKD complications, improve patient outcomes, and reduce mortality.
• Further clinical studies are warranted to fully elucidate the protective role of vitamin D analogs in renal transplantation and acute rejection.
• Understanding vitamin D's pleiotropic effects can guide therapeutic interventions to improve the quality of life for CKD patients.