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Vitamin D in Patients with Chronic Kidney Disease: Nothing New under the Sun

Marcello Tonelli, MD, SM
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From University of Alberta and Institute of Health Economics, Edmonton, Alberta T6G 2G3, Canada.

Grant Support: Dr. Tonelli is supported by salary awards from the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research.

Potential Financial Conflicts of Interest: Dr. Tonelli holds peer-reviewed research funding from the Centre for D-Receptor Activation Research to examine vitamin D status in remote-dwelling patients on dialysis.

Current Author Address: Marcello Tonelli, MD, SM, 7-129 Clinical Sciences Building, 8440-112 Street, Edmonton, Alberta T6G 2G3, Canada; e-mail, no_reprints@med.ualberta.ca.

Ann Intern Med. 2007;147(12):880-881. doi:10.7326/0003-4819-147-12-200712180-00009
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Vitamin D deficiency—a common occurrence in patients with chronic kidney disease—plays an integral role in the development of secondary hyperparathyroidism, which in turn can lead to bone fractures and disability. The active form of vitamin D has hydroxyl groups at the 1 and 25 positions. Current options for vitamin D replacement in patients with chronic kidney disease include nonhydroxylated vitamin D (ergocalciferol, cholecalciferol), 25-hydroxyvitamin D, and activated forms. The latter include 1,25-hydroxyvitamin D and the 1-hydroxylated prohormone, which is subsequently 25-hydroxylated by the liver. Because 1-hydroxylase activity is impaired in chronic kidney disease, activated vitamin D offers theoretical advantages over vitamin D compounds that are not 1-hydroxylated and has been prescribed to dialysis patients for more than 20 years. Initially 1,25 hydroxyvitamin D (calcitriol) was used, although the use of vitamin D analogues (chemically modified dihydroxylated compounds, such as paricalcitol and doxercalciferol) is increasingly common.

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