Vitamin D supplementation for patients with chronic kidney disease: A systematic review and meta-analyses of trials investigating the response to supplementation and an overview of guidelines

Christodoulou, Marilena, Aspray, Terence J. and Schoenmakers, Inez (2021) Vitamin D supplementation for patients with chronic kidney disease: A systematic review and meta-analyses of trials investigating the response to supplementation and an overview of guidelines. Calcified Tissue International, 109. 157–178. ISSN 0171-967X

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Abstract

A large proportion of patients with chronic kidney disease (CKD) are vitamin D deficient (plasma 25-hydroxyvitamin D (25(OH)D) < 25 or 30 nmol/L per UK and US population guidelines) and this contributes to the development of CKD–mineral bone disease (CKD–MBD). Gaps in the evidence-base for the management of vitamin D status in relation to CKD–MBD are hindering the formulation of comprehensive guidelines. We conducted a systemic review of 22 RCTs with different forms of vitamin D or analogues with CKD–MBD related outcomes and meta-analyses for parathyroid hormone (PTH). We provide a comprehensive overview of current guidelines for the management of vitamin D status for pre-dialysis CKD patients. Vitamin D supplementation had an inconsistent effect on PTH concentrations and meta-analysis showed non- significant reduction (P = 0.08) whereas calcifediol, calcitriol and paricalcitol consistently reduced PTH. An increase in Fibroblast Growth Factor 23 (FGF23) with analogue administration was found in all 3 studies reporting FGF23, but was unaltered in 4 studies with vitamin D or calcifediol. Few RCTS reported markers of bone metabolism and variations in the range of markers prevented direct comparisons. Guidelines for CKD stages G1–G3a follow general population recommendations. For the correction of deficiency general or CKD-specific patient guidelines provide recommendations. Calcitriol or analogues administration is restricted to stages G3b–G5 and depends on patient characteristics. In conclusion, the effect of vitamin D supplementation in CKD patients was inconsistent between studies. Calcifediol and analogues consistently suppressed PTH, but the increase in FGF23 with calcitriol analogues warrants caution.

Item Type: Article
Uncontrolled Keywords: chronic kidney disease,guidelines,systematic review,vitamin d deficiency,vitamin d supplementation,endocrinology, diabetes and metabolism,orthopedics and sports medicine,endocrinology ,/dk/atira/pure/subjectarea/asjc/2700/2712
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 26 Apr 2021 23:47
Last Modified: 21 Jul 2021 01:46
URI: https://ueaeprints.uea.ac.uk/id/eprint/79883
DOI: 10.1007/s00223-021-00844-1

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