Vitamin D Supplementation in Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies and Randomized Controlled Trials

CJASN January 2011 vol. 6 no. 1 50-62 , published by American Society of Nephrology

1. Praveen Kandula,

2. Mirela Dobre,

3. Jesse D. Schold,

4. Martin J. Schreiber ,

5. Rajnish Mehrotra,

6. Sankar D. Navaneethan

   • Author Affiliations

7. *Department of Nephrology, Indiana University, Indianapolis, Indiana;

8. Department of Internal Medicine, Huron Hospital, Cleveland, Ohio;

9. Department of Nephrology, Case Western Reserve University, Cleveland, Ohio;

10. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, and

11. Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;

12. Los Angeles Biomedical Research Institute at Harbor–University of California–Los Angeles Medical Center, Torrance, California; and

13. David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California

14. Correspondence:

Dr. Sankar D. Navaneethan, Department of Nephrology and Hypertension, Cleveland Clinic, 9500 Euclid Avenue, Q7, Cleveland, OH 44195. Phone: 216-636-9230; Fax: 216-444-9378; E-mail: navanes@ccf.org

Background and objectives Vitamin D deficiency is highly prevalent among patients with chronic kidney disease (CKD). The benefits and harms of vitamin D supplementation (ergocalciferol or cholecalciferol) were assessed in patients with nondialysis-dependent CKD, dialysis-dependent CKD, and renal transplant recipients.

Design, setting, participants, & measurements MEDLINE ( 1966 to September 2009 ), SCOPUS (September 2009), and nephrology conference proceedings were searched for relevant observational and randomized controlled trials (RCTs). Treatment effects were summarized as mean differences (MDs) with 95% confidence intervals (CIs) using a random effects model. Separate analyses were conducted for observational studies and RCTs.

Results Twenty-two studies (17 observational and 5 RCTs) were included. There was a significant improvement in 25-hydroxyvitamin D (MD 24.1 ng/ml, 95% CI 19.6 to 28.6) and an associated decline in parathyroid hormone (PTH) levels (MD ?41.7 pg/ml, 95% CI ?55.8 to ?27.7) among observational studies. PTH reduction was higher in dialysis patients. Among RCTs, there was a significant improvement in 25-hydroxyvitamin D (MD 14 ng/ml, 95% CI 5.6 to 22.4) and an associated decline in PTH levels (MD ?31.5 pg/ml, 95% CI ?57 to ?6.1). A low incidence of hypercalcemia and hyperphosphatemia was reported with vitamin D supplementation. Cardiovascular and skeletal effects of vitamin D supplementation have not been studied. Included studies were mostly of low to moderate quality.

Conclusions Available evidence from low-to-moderate quality observational studies and fewer RCTs suggests that vitamin D supplementation improves biochemical endpoints. However, whether such improvements translate into clinically significant outcomes is yet to be determined.

See also VitaminDWiki

• Overview Kidney and vitamin D

• All Kidney and Vitamin D items in VitaminDWiki 63 items Aug 2011

• Application to FDA for use of active Vitamin D for hemodialysis patients – July 2011

• Dialysis patients with low vitamin D were 2.7 X more likely to die of heart problems – Feb 2011

• Virtually all black dialysis patients with low albumin are vitamin D deficient in the winter – Mar 2010

• Low vitamin D associated with hemodialysis problems – May 2010

• Kidney failure and vitamin D deficiency vicious cycle – Jan 2011

• Each 10 ng increase in vitamin D decreased kidney disease death by 14 percent – May 2011 Meta-analysis