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Updated: May 16, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Effect of cholecalciferol on immune and vascular function in non-diabetic chronic kidney disease
Kajal Kamboj1, Aruna Pariki2, Manphool Singhal2
1Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Vitamin D supplementation improved immune and vascular functions in patients with chronic kidney disease (CKD). Cholecalciferol treatment shifted immune balance towards TH2, reduced inflammation, and enhanced blood vessel function.
Area of Science:
- Nephrology
- Immunology
- Cardiovascular Medicine
Background:
- Vitamin D deficiency is common in chronic kidney disease (CKD) patients.
- It may contribute to cardiovascular disease (CVD) by affecting immune and endothelial functions.
Purpose of the Study:
- To investigate the effects of vitamin D supplementation on immune and vascular functions.
- Focus on non-diabetic individuals with stage 3-4 CKD and vitamin D deficiency.
Main Methods:
- Single-arm study with 62 non-diabetic CKD subjects (eGFR 15-60 ml/min/1.73m²).
- Administered 300,000 IU oral cholecalciferol at baseline and 8 weeks.
- Assessed immunological, vascular, endothelial, inflammatory, and biochemical parameters at baseline and 16 weeks.
Main Results:
- Cholecalciferol increased TH2 cells and decreased TH1 cells, indicating a shift in immune phenotype.
- Observed increased mRNA expression of vitamin D-responsive genes (cathelicidin, IL-10, VDR, CYP27B1).
- Reduced pro-inflammatory cytokines (IFN-γ, TNF-α, IL-23, IL-6) and increased anti-inflammatory cytokines (IL-4, IL-10, IL-13).
- Significantly improved flow-mediated dilatation (FMD) from 8.2% to 14.1% (p<0.001).
Conclusions:
- Cholecalciferol supplementation positively influences immune function in CKD patients.
- It promotes a TH2-dominant immune response and reduces inflammation.
- Supplementation also enhances vascular function, suggesting a role in mitigating CVD risk in CKD.
Background And Aims:
Vitamin D deficiency, widely prevalent in patients with chronic kidney disease (CKD) could play a role in the pathogenesis of cardiovascular disease (CVD) by causing alterations in endothelial and immune function. We investigated the change in immune and vascular functions following vitamin D supplementation in non-diabetic subjects with stage 3-4 CKD and vitamin D deficiency.
Methods:
In this single-arm study, non-diabetic CKD subjects aged 18-75 years, eGFR 15-60 ml/min/1.73m2, and serum 25-hydroxyvitamin D3 levels <20 ng/ml were enrolled. Enrolled subjects received a directly observed oral dose of 300,000 IU cholecalciferol at baseline and 8 weeks. Outcome assessments, including immunological, vascular, endothelial, inflammatory, and biochemical parameters, were measured at baseline and 16 weeks.
Results:
In total, 62 subjects were studied. The mean age was 44 ± 12 years with 58% men. TH1 cells decreased from 17% (9%, 27%) to 11% (6%, 16%) (p=0.002) and TH2 cells increased from 9% (5%, 16%) to 16% (10%, 27%) (p=0.001) after cholecalciferol treatment. A significant increase in mRNA expression of vitamin D-responsive genes (cathelicidin, IL-10, VDR, and CYP27B1) was observed. The levels of pro-inflammatory cytokines (IFN-γ, TNF-α, IL-23, and IL-6) decreased whereas anti-inflammatory cytokines (IL-4, IL-10, and IL-13) showed an increase. Cholecalciferol treatment improved flow-mediated dilatation (FMD): 8.2% (6.2%, 12.1%) at baseline to 14.1% (10.0%, 20.1%) at 16 weeks (p<0.001).
Conclusions:
This study confirms that cholecalciferol supplementation influenced immune function as it favored the TH2/TH1 phenotype, favorably affected the levels of inflammatory markers and mRNA expression of vitamin D responsive genes, and improved vascular function in CKD.
Clinical Trial Registration:
https://www.ctri.nic.in, identifier CTRI/2019/10/021494.
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