James B. Wetmore, MD
In patients with chronic kidney disease (CKD) not requiring dialysis, does treatment with vitamin D provide clinical benefit?
Included studies evaluated vitamin D compounds for management of CKD mineral and bone disorders compared with placebo/no treatment or another vitamin D compound in patients of all ages with CKD not requiring dialysis. Also included were studies comparing different schedules, routes, or doses of vitamin D. Outcomes were mortality, need for dialysis, reduction in parathyroid hormone (PTH), hypercalcemia, and hyperphosphatemia.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Renal Group’s specialized register, Cochrane Central Register of Controlled Trials, and references were searched for randomized (or quasi-randomized) controlled trials (RCTs). 16 RCTs (n = 894) met the selection criteria: 14 RCTs in adults (mean age 48 to 63 y, 40% to 69% men) and 2 RCTs in children (mean age 5.5 to 8.5 y, 67% to 76% boys). Adequate allocation concealment was reported in 3 trials, and blinding was reported in 7 trials. Duration of follow-up ranged from 0.5 to 28 months.
Vitamin D did not reduce mortality or need for dialysis (Table). Compared with placebo, vitamin D lowered PTH by a mean 49 pg/mL (95% CI 13 to 86; 4 RCTs, n = 153) and increased the chance of a > 30% reduction from baseline (risk ratio 7.9, CI 4.9 to 13; 2 RCTs, n = 264). Established vitamin D compounds (calcitriol and alfacalcidol), but not newer vitamin D compounds (doxercalciferol and paricalcitol), increased risk for hypercalcemia and hyperphosphatemia (Table).
In patients with chronic kidney disease not requiring dialysis, current evidence is insufficient to show that vitamin D provides clinical benefit.
Vitamin D vs placebo in patients with chronic kidney disease not requiring dialysis*
*Abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from data in article using a random-effects model.
Wetmore JB. Review: Insufficient evidence exists on the benefit of vitamin D in patients with chronic kidney disease not requiring dialysis. Ann Intern Med. ;152:JC4–12. doi: 10.7326/0003-4819-152-8-201004200-02012
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Published: Ann Intern Med. 2010;152(8):JC4-12.
Chronic Kidney Disease, Nephrology, Renal Replacement Therapy.
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