Impact of Vitamin D on the Cardiovascular System in Advanced Chronic Kidney Disease (CKD) and Dialysis Patients.

Anna Gluba-Brzózka,Jacek Rysz,Beata Franczyk,Aleksandra Ciałkowska-Rysz,Robert Olszewski

doi:10.3390/nu10060709

Abstract

In patients suffering from chronic kidney disease (CKD), the prevalence of cardiovascular disease is much more common than in the general population. The role of vitamin D deficiency had been underestimated until a significant association was found between vitamin D therapy and survival benefit in haemodialysis patients. Vitamin D deficiency is present even in the early stages of chronic kidney disease. The results of experimental studies have revealed the relationship between vitamin D deficiency and impairment of cardiac contractile function, higher cardiac mass and increased myocardial collagen content. Experimental models propose that intermediate end points for the relationship between vitamin D deficiency and higher risk of cardiovascular disease comprise diminished left ventricular hypertrophy (LVH), enhanced left ventricular diastolic function, and decreased frequency of heart failure. Multiple observational studies have demonstrated an association between the use of active vitamin D therapy in patients on dialysis and with CKD and improved survival. However, there are also many studies indicating important adverse effects of such treatment. Therefore, large randomized trials are required to analyze whether supplementation of vitamin D may affect outcomes and whether it is safe to be used in CKD patients.

Highlights

In patients suffering from chronic kidney disease (CKD), the prevalence of cardiovascular disease is much more common than in the general population [1]
Either relative or absolute vitamin D deficiency of 25(OH)D in patients with CKD and end-stage renal disease (ESRD) as well as in general population have been associated with all-cause mortality, cardiovascular events, peripheral vascular disease, congestive heart failure, hypertension and the later need for renal replacement therapy [19,23,33,34,35,36]
The administration of vitamin D was associated with lower mortality compared to those with no treatment (adjusted case mixed baseline model: hazard ratio (HR), 0.74; 95% confidence interval, 0.67–0.82; p

Summary

Introduction

In patients suffering from chronic kidney disease (CKD), the prevalence of cardiovascular disease is much more common than in the general population [1]. Their high morbidity and mortality cannot be explained by traditional cardiovascular risk factors, such as advanced age, the presence of diabetes, hypertension, hypertriglyceridemia and low levels of high-density lipoprotein (HDL) cholesterol [2]. In the opinion of Institute of Medicine Committee, evidences that vitamin D prevented cardiovascular disease, diabetes, or other cardiometabolic outcomes are inconsistent and inconclusive [16] They do not meet criteria for establishing a cause–effect relationship. Low levels of 25(OH)D in patients with kidney disease may be due to the loss of vitamin D binding protein in the urine [17], defective photoproduction in the skin following the exposure to ultraviolet B radiation [18], and likely reduced nutritional intake and sun exposure [19]

Vitamin D and Its Deficiency

Vitamin D Deficiency Treatment

Mechanisms Associated with Vitamin D Status

Guidelines

Findings

Summary