VDR Activation in CKD

Abstract

Disturbances of mineral metabolism occurs in virtually all patients during the progression of chronic kidney disease (CKD), because the decreasing functional renal mass and the reduction in renal 1a-hydroxylase activity lead to defective renal production of calcitriol at very early CKD stages. Beyond the effect of parathyroid hormone suppression, an increasing body of experimental data suggests that vitamin D exerts pleiotropic effects, which have been associated with an improvement of cardiovascular disease and mortality rate in observational studies. Recent data from randomized controlled studies showed that paracalcitol treatment in CKD patients also results in a significant reduction of albuminuria, which is a major risk factor for cardiorenai syndrome outcome. However, the current K/DOQI and KDIGO recommendations limit the administration of VDR activation agents for the sole treatment of hyperparathyroidism. The role of different vitamin D metabolites and their analogues, administered in CKD patients, will be discussed in this review.