Vitamin D in CKD

1. 25-OH Vit D therapy in CKD
stage 2-5
Dr Dhanin.P
27/9/17

2. Introduction
• Two major forms
– Ergocalciferol(vit D2) and Cholecalciferol (D3)
• 25 (OH) D : major biomarker of total vit D store
• Vit D binding protein
• Vit D receptor
• Fat soluble vitamin

7. Guidelines for 25 OH Vit D
• In 1976, Eastwood et al showed low levels of
25(OH)D in patients with both CKD
• In 1975,Chertow et al discovered that
administration of the Active vit D reduces PTH
secretion in rats.
• 2003 KDOQI clinical practice guideline:

9. • KDIGO CKD-MBD 2017
• CKD G3-5 : optimal PTH unknown
• Native vit D supplementation as previously
• Calcitriol & vit D analogues not routinely are
recommended

10. Threshold for treatment
• 30 ng/dl
• Sufficient; insufficient; deficient
• On the basis of maximal PTH suppression
• Depends on the Ca intake
• Ehnicity

11. Non bone disease indication
• 1 α hydroxylase : Placenta, GI tract, skin, blood
vessels, and granulomatous tissue
• Subtle vit D deficiency : Risk for hypertension,
obesity, diabetes, cardiovascular diseases,
autoimmune diseases, asthma, and depression
• Presence of vit D receptors
• NKF-KDOQI and KDIGO guidelines did not
recommend supplementing 25(OH)D for non–bone-
related chronic diseases in patients with CKD

12. Conclusion
• Measure
• Monitor
• Target
• Preparation
• Toxicity