Vitamin D and Chronic Kidney Disease

Vitamin D is one of the fat-soluble vitamins. It has been recognized for over a century that Vitamin D is necessary for healthy bone growth through the actions of Vitamin D on calcium absorption. A lack of Vitamin D is responsible for the now, fortunately rare, condition of defective bone growth called rickets.


Vitamin D is also active in controlling cell turnover, called cell proliferation. As such, Vitamin D may be helpful in cancer suppression. Vitamin D may also play a part in cardiac health and other immune functions.


Natural Vitamin D is processed from a precursor in the skin to an active form by the action of ultraviolet light. Vitamin D also requires further processing to become active in both the liver and the kidneys.

Patients with kidney function may make insufficent amounts of active Vitamin D and require supplementation.


How much Vitamin D is necessary or ideal for overall good health has come into question in the last few years. Most vitamin concentrations in the body require a delicate balance between too much and too little, as both may have harmful side effects. Please discuss your Vitamin D requirements with your health care provider. Page updated January 18 2013 Author Interview: Dr Pablo Urena MD

Efficacy of cinacalcet with low-dose vitamin D in incident haemodialysis subjects with secondary hyperparathyroidism

Pablo Ureña-Torres, Ian Bridges, Cynthia Christiano, Serge H. Cournoyer, Kerry Cooper, Mourad Farouk, Nelson P. Kopyt, Mariano Rodriguez, Daniel Zehnder, and Adrian Covic

Nephrol. Dial. Transplant. first published online January 16, 2013 doi:10.1093/ndt/gfs568 Authors' Interview:

Kamyar Kalantar-Zadeh, MD, MPH, PHD and Miklos Zsolt Molnar, MD, PhD

Administered paricalcitol dose and survival in hemodialysis patients: A marginal structural model analysis.
Miller, J. E., Molnar, M. Z., Kovesdy, C. P., Zaritsky, J. J., Streja, E., Salusky, I., Arah, O. A. and Kalantar-Zadeh, K. (2012), Administered paricalcitol dose and survival in hemodialysis patients: A marginal structural model analysis. Pharmacoepidem. Drug Safe.. doi: 10.1002/pds.3349 Author Interview: Ian H. de Boer, MD, MS

The serum 24,25-dihydroxyvitamin D concentration, a marker of vitamin D catabolism, is reduced in chronic kidney disease.
Bosworth CR, Levin G, Robinson-Cohen C, Hoofnagle AN, Ruzinski J, Young B, Schwartz SM, Himmelfarb J, Kestenbaum B, de Boer IH.
Department of Medicine, Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, Washington, USA.
Kidney Int. 2012 May 30. doi: 10.1038/ki.2012.193. [Epub ahead of print]

Author Interview: D. L. Mason, PharmD, BCPS

Nervous system autoantibodies and vitamin D receptor gene polymorphisms in hemodialysis patients.
Mason, D. L., Assimon, M. M., Bishop, J. R. and El-Fawal, H. A. N. (2012)
Hemodialysis International. doi: 10.1111/j.1542-4758.2012.00727.x

Author Interview: Peter Marckmann, MD, DMSc,
Clinical Research Unit, Department of Nephrology,
Brovej 5, Veddelev, DK-4000 Roskilde, Denmark

Randomized Controlled Trial of Cholecalciferol Supplementation in CKD Patients with Hypovitaminosis

Author Interview: Prof Mario Cozzolino MD, PhD

VDRA therapy is associated with improved survival in dialysis patients with serum intact PTH ≤150 pg/mL:
results of the Italian FARO Survey

Mario Cozzolino, Diego Brancaccio, Giuseppe Cannella, Piergiorgio Messa,Loreto Gesualdo, Martino Marangella, Cosimo LoDeserto, Marco Pozzato,Giuseppe Rombolà, Anna Maria Costanzo, Umberto di Luzio Paparatti ,Sandro Mazzaferro, and on behalf of the FARO Study Group

Nephrol. Dial. Transplant. first published online April 20, 2012 doi:10.1093/ndt/gfs108

Jose M. Valdivielso, PhD

Assessment of the Potential Role of Active Vitamin D Treatment in Telomere Length: A Case-Control Study in Hemodialysis Patients.

Borras M, Panizo S, Sarró F, Valdivielso JM, Fernandez E.
Nephrology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
Clin Ther. 2012 Mar 12. [Epub ahead of print]

Author Interview: Dr. Tamara Isakova
Daily Variability in Mineral Metabolites in CKD and Effects of Dietary Calcium and Calcitriol

Tamara Isakova, Huiliang Xie, Allison Barchi-Chung, Kelsey Smith, Nicole Sowden,Michael Epstein, Gina Collerone, Leigh Keating, Harald Jüppner, and Myles Wolf

CJASN CJN.11721111; published ahead of print March 1, 2012,doi:10.2215/CJN.11721111

Author Interview: Ravi Thadhani, MD, MPH
Vitamin D Therapy and Cardiac Structure and Function in Patients With Chronic Kidney Disease
The PRIMO Randomized Controlled Trial

Ravi Thadhani, Evan Appelbaum, Yili Pritchett, Yuchiao Chang, Julia Wenger, Hector Tamez, Ishir Bhan, Rajiv Agarwal, Carmine Zoccali, Christoph Wanner, Donald Lloyd-Jones, Jorge Cannata, B. Taylor Thompson, Dennis Andress, Wuyan Zhang, David Packham, Bhupinder Singh, Daniel Zehnder, Amil Shah, Ajay Pachika, Warren J. Manning, Scott D. Solomon

JAMA. 2012;307(7):674-684.doi:10.1001/jama.2012.120

Author Interview: David M. Spiegel, MD, FACP

A Computerized Treatment Algorithm Trial to Optimize Mineral Metabolism in ESRD

David M. Spiegel, Lesley McPhatter, Ann Allison, Joanne C. Drumheller, and Robert Lockridge

CJASN CJN.08170811; published ahead of print February 2012 doi:10.2215/CJN.08170811

Author Interview: Meri J. Ala-Houhala, MD

Narrow-band ultraviolet B exposure increases serum vitamin D levels in haemodialysis patients

Meri J. Ala-Houhala, Katja Vähävihu, Taina Hasan, Hannu Kautiainen, Erna Snellman, Piia Karisola, 
Yvonne Dombrowski, Jürgen Schauber, Heikki Saha, and Timo Reunala
Nephrol.Dial. Transplant. doi:10.1093/ndt/gfr700

Author Interview: Darius Mason, Pharm.D.,BCPS

Nutritional vitamin D supplementation in hemodialysis: a potential vascular benefit?

Magdalene M. Assimon Pharm.D, Page V. Salenger MD,  Hassan A.N. El-Fawal PhD, Darius L. Mason Pharm.D., BCPS
DOI: 10.1111/j.1440-1797.2011.01555.x

Author Interview: Dr. Ditte Hansen MD PhD

Changes in fibroblast growth factor 23 during treatment of secondary hyperparathyroidism with alfacalcidol or paricalcitol

Ditte Hansen, Knud Rasmussen, Susanne M. Pedersen, Lars M. Rasmussen, and Lisbet Brandi

Nephrol. Dial. Transplant. first published online December 1, 2011

Author Interview: T. Christopher Bond, Ph.D.

Effects of Switching from Intravenous Paricalcitol to Doxercalciferol on Dialysis Patient Bone and Mineral Outcomes

T. Christopher Bond, PhD, Steven M. Wilson, PhD, Mahesh Krishnan, MD, FASN, Tracy Jack Mayne, PhD.
DaVita Clinical Research, Minneapolis, MN.

ASN 2011 Abstract: [FR-PO1266]

Author Interview: Dr. Fátima Guerrero

The effect of vitamin D derivatives on vascular calcification associated with inflammation.

1Department Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain.
Guerrero F, Montes de Oca A, Aguilera-Tejero E, Zafra R, Rodríguez M, López I.
Nephrol Dial Transplant. 2011 Oct 24.

Author Interview: Dr. Eva Jakopin

High-dose cholecalciferol supplementation for vitamin D deficiency in haemodialysis patients.

Jakopin E, Pecovnik Balon B, Ekart R, Gorenjak M.
Department of Nephrology, University Medical Centre Maribor, Maribor, Slovenia.
J Int Med Res. 2011;39(3):1099-106.

Author Interview: Dr. Roman Fiedler
Vitamin D Deficiency, Mortality, and Hospitalization in Hemodialysis Patients with or without Protein-Energy Wasting.

Fiedler R, Dorligjav O, Seibert E, Ulrich C, Markau S, Girndt M.Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
Nephron Clin Pract. 2011 Aug 11;119(3):c220-c226

Author Interview: Dr. Ian De Boer
Serum 25-Hydroxyvitamin D and Change in Estimated Glomerular Filtration Rate.

de Boer IH, Katz R, Chonchol M, Ix JH, Sarnak MJ, Shlipak MG,
Siscovick DS, Kestenbaum B.
Clin J Am Soc Nephrol. 2011 Aug 11.

Author Interview: Dr. Giuseppe Cianciolo

VDR Expression on Circulating Endothelial Progenitor Cells in Dialysis Patients Is Modulated by 25(OH)D Serum Levels and Calcitriol Therapy.
Cianciolo G, La Manna G, Cappuccilli ML, Lanci N, Della Bella E, Cuna V, Dormi A, Todeschini P, Donati G, Alviano F, Costa R, Bagnara GP, Stefoni S.
Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy.
Blood Purif. 2011 Jul 9;32(3):161-173.

Author Interview: Maria Ayako Kamimura, PhD
Risk Factors for Hypovitaminosis D in Nondialyzed Chronic Kidney Disease Patients.

Figuiredo-Dias V, Cuppari L, Garcia-Lopes MG, de Carvalho AB, Draibe SA, Kamimura MA.
J Ren Nutr. 2011 Jun 6.
Nutrition Program, Federal University of São Paulo, São Paulo, Brazil

Author Interview: Dr. KS Kant

Converting to Doxercalciferol Capsules From Intravenous Paricalcitol or Doxercalciferol.
Kant KS, Gonzalez AR, Hariachar S, Bernardo M, Duggal A, Engstrand S, Hunter J, Plone M, Hertel J.

J Ren Nutr. 2011 Jun 6.

Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, College of Medicine, Cincinnati, Ohio.

Author Interview:  Dr. David Pierce, Ph.D.
The effect of sevelamer carbonate and lanthanum carbonate on the pharmacokinetics of oral calcitriol.

Pierce D, Hossack S, Poole L, Robinson A, Van Heusen H, Martin P, Smyth M.
Nephrol Dial Transplant. 2011 May;26(5):1615-21

Author Interview: Dr. Roberto Pecoits-Filho

Hypovitaminosis D Is Associated with Systemic Inflammation and Concentric Myocardial Geometric Pattern in Hemodialysis Patients with Low iPTH Levels

Bucharles S, Barberato SH, Stinghen AE, Gruber B, Meister H, Mehl A, Piekala L, Dambiski AC, Souza A, Olandoski M, Pecoits-Filho R.
Nephron Clin Pract. 2011 Feb 16;118(4):c384-c391.
Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.

Author Interview Dr William Petchey Cardiorespiratory fitness is independently associated with 25-hydroxyvitamin D in chronic kidney disease

Clin J Am Soc Nephrol. 2011 Mar;6(3):512-8
Petchey WG, Howden EJ, Johnson DW, Hawley CM, Marwick T, Isbel NM.

Vitamin D in Chronic Kidney Disease: New Potential for Intervention.

Curr Drug Targets. 2010 Aug 27.

Mirkovic K, van den Born J, Navis G, de Borst MH.
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, the Netherlands.

Comparative Effectiveness of Intravenous Vitamin D Agents

Carey Colson, Mahesh Krishnan, Tracy Jack Mayne, Allen R. Nissenson. DaVita Inc., Denver, CO
November 19, 2010  American Society Nephrology

Background: The topic of comparative effectiveness research (CER) of therapeutic agents has risen to top of the national healthcare debate with the recent passage of healthcare reform. Dialysis electronic health records provide a unique environment for evaluating CER across multiple categories. We undertook an evaluation of two intravenous vitamin D agents used for in-center end stage renal disease (ESRD). (continued)

Read the Author Interview on Comparative Effectiveness of Intravenous Vitamin D Agents

Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients.

Eur Heart J. 2010 Aug 5.

Drechsler C, et al
Department of Internal Medicine 1, Division of Nephrology, University of Würzburg, Oberdürrbacher Str. 6, D-97080 Würzburg, Germany.

Dietary Vitamin D Intake in Advanced CKD/ESRD.

Semin Dial. 2010 Jul;23(4):407-10.
Bhan I, Hewison M, Thadhani R.
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts

Seasonal variation of vitamin D in patients on hemodialysis.
Clin Nephrol. 2010 Jul;74(1):19-24.

Tolouian R, et al

25-Hydroxyvitamin D Levels, Race, and the Progression of Kidney Disease
Journal of the American Society of Nephrology March 2009

This article reports on the low levels of Vitamin D found in non-Hispanic patients of color and increased levels of chronic kidney disease. The authors report that this is an association but does not necessarily imply causation.

This study highlights factors that increase the risk of Vitamin D deficiency, including:
Black race, female sex, winter season, and hypoalbuminemia ( low level of albumin, a blood protein).

The authors concluded: Deficiency of 25-hydroxyvitamin D is nearly universal among patients with hypoalbuminemia initiating chronic hemodialysis in winter.

Use of vitamin D in chronic kidney disease patients.

Kidney Int. 2010 May 26.
Gal-Moscovici A, Sprague SM.
Hebrew University of Jerusalem, Hadassah Hospital, Ein Keren, Jerusalem, Israel.
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