Renal and Transplantation Unit, St George's University Hospital NHS Foundation Trust, London, UK.
Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
Nephrology (Carlton). 2019 Aug;24(8):781-790. doi: 10.1111/nep.13569. Epub 2019 May 2.
Patients with chronic kidney disease (CKD) experience excess cardiovascular morbidity and mortality that is unexplained by traditional cardiovascular risk factors. Vitamin D deficiency is highly prevalent in CKD and is associated with increased cardiovascular mortality in both the general population and in CKD patients. Vitamin D supplementation is a reasonably safe and simple intervention and meta-analyses of observational studies have suggested that vitamin D supplementation in CKD improves cardiovascular mortality. However, randomized controlled trials examining the impact of vitamin D supplementation in improving surrogate markers of cardiovascular structure and function remain inconclusive. This review investigates the impact of vitamin D supplementation on surrogate end-points and cardiovascular events from trials in CKD; and discusses why results have been heterogenous, particularly critiquing the effect of different dosing regimens and the failure to take into account the implications of vitamin D supplementation in study participants with differing vitamin D binding protein genotypes.
患有慢性肾病（CKD）的患者经历心血管发病率和死亡率过高，这无法用传统的心血管危险因素来解释。维生素 D 缺乏在 CKD 中非常普遍，并且与普通人群和 CKD 患者的心血管死亡率增加有关。维生素 D 补充是一种合理安全且简单的干预措施，对观察性研究的荟萃分析表明，维生素 D 补充可改善 CKD 的心血管死亡率。然而，检查维生素 D 补充对心血管结构和功能替代标志物的影响的随机对照试验结果仍不一致。本综述调查了维生素 D 补充对 CKD 试验中替代终点和心血管事件的影响；并讨论了为什么结果存在异质性，特别是批评了不同剂量方案的影响，以及未能考虑到不同维生素 D 结合蛋白基因型的研究参与者中维生素 D 补充的影响。
