Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
J Nephrol. 2024 Jul;37(6):1477-1485. doi: 10.1007/s40620-024-02055-x. Epub 2024 Sep 2.
Chronic kidney disease (CKD) poses a significant epidemiological challenge, necessitating effective patient management strategies. Nutritional intervention, particularly vitamin D supplementation, has garnered attention for its potential therapeutic utility in CKD. Despite widespread acknowledgment of the importance of vitamin D, particularly in bone and mineral metabolism, its supplementation in CKD patients for non-skeletal purposes remains contentious due to limited evidence. Hypovitaminosis D linked with CKD substantially contributes to disturbances in mineral and bone metabolism, increasing the risks of cardiovascular complications and skeletal disorders. Notably, CKD patients experience progressive vitamin D deficiency, exacerbating as the disease progresses. Guidelines recommend monitoring 25-hydroxyvitamin D (25 (OH)-D) levels due to their correlation with mineral metabolism parameters, although robust evidence for recommending supplementation is lacking. The primary aim of this paper is to focus on the main open questions regarding vitamin D supplementation in CKD, reporting the current evidence concerning the role of vitamin D supplementation in CKD and in renal transplant recipients.
慢性肾脏病（CKD）构成了重大的流行病学挑战，需要采取有效的患者管理策略。营养干预，特别是维生素 D 补充，因其在 CKD 中的潜在治疗作用而受到关注。尽管人们普遍认识到维生素 D 的重要性，特别是在骨骼和矿物质代谢方面，但由于证据有限，其在 CKD 患者中的非骨骼用途的补充仍存在争议。与 CKD 相关的低维生素 D 血症极大地导致了矿物质和骨骼代谢的紊乱，增加了心血管并发症和骨骼疾病的风险。值得注意的是，CKD 患者经历维生素 D 的进行性缺乏，随着疾病的进展而恶化。由于其与矿物质代谢参数相关，指南建议监测 25-羟维生素 D（25（OH）-D）水平，尽管缺乏推荐补充的有力证据。本文的主要目的是关注 CKD 中维生素 D 补充的主要开放性问题，报告关于维生素 D 补充在 CKD 和肾移植受者中的作用的现有证据。
