Abstract
Vitamin D deficiency is common in both the general population and CKD patients. Currently defined as a circulating 25-dihydroxyvitamin D (25(OH)D) level below 20 ng/mL (50 nmol/L), it is a major risk factor for bone and mineral disorders and has been related to increased risk of non-skeletal health outcomes including mortality, diabetes, and cardiovascular disease. A greater prevalence of this deficiency is expected in patients with CKD because they are older and more likely to have dark skin, obesity, and associated comorbidities such as diabetes and hypertension. In studies of clinical populations, the mean circulating 25(OH)D levels ranged from 18 to 29 ng/mL for patients with non-end-stage CKD and from 12 to 32 ng/mL for those on dialysis. Large population-based and clinical studies, however, describe inconsistent findings about the association between kidney function and vitamin D level. While some studies report significant, positive, and independents associations between glomerular filtration rate and circulating 25(OH)D values, others show low levels only in advanced CKD stages. Still others show no or even an inverse association, with paradoxically higher levels of 25(OH)D in individuals with moderate CKD than in those without CKD. Similarly, it remains unclear whether these discordant relations are direct and causal, or indirect because of confounders. Only a few studies have examined the relations between proteinuria or albuminuria and circulating 25(OH)D levels; they generally report significant negative associations. Potential mechanisms supporting a causal relation between kidney function and damage and vitamin D are discussed at the end of this chapter.
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Metzger, M., Stengel, B. (2016). Epidemiology of Vitamin D Deficiency in Chronic Kidney Disease. In: Ureña Torres, P., Cozzolino, M., Vervloet, M. (eds) Vitamin D in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-32507-1_2
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