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29.10.2018 | Educational Review | Ausgabe 12/2019

Pediatric Nephrology 12/2019

Vitamin D and cardiovascular disease in chronic kidney disease

Zeitschrift:
Pediatric Nephrology > Ausgabe 12/2019
Autoren:
Gurpreet Kaur, Jatinder Singh, Juhi Kumar
Wichtige Hinweise

Key points

• Inadequate vitamin D levels (< 30 ng/ml) are highly prevalent in the adult and pediatric chronic kidney disease populations.
• Vitamin D deficiency is associated with hypertension, diabetes, proteinuria cardiac dysfunction, and dyslipidemia.
• Low vitamin D levels upregulate the renin-angiotensin-aldosterone system, increase inflammation, and cause endothelial dysfunction leading to higher cardiovascular risk.
• Clinical trials and meta-analyses data in adults have failed to show a benefit of vitamin D therapy on cardiovascular outcomes.
• Lack of randomized clinical trials and high-quality evidence in the pediatric CKD population makes it difficult to recommend the use of vitamin D therapy for reduction of cardiovascular disease burden.
Answers
1. c; 2. a; 3. d; 4. e; 5. c

Abstract

Chronic kidney disease (CKD) is considered an independent risk factor for cardiovascular disease, with increased cardiovascular morbidity and mortality seen even in the early stages of CKD. Several studies have shown a high prevalence of vitamin D deficiency in individuals with CKD. Low vitamin D levels upregulate the renin-angiotensin-aldosterone system (RAAS), cause endothelial dysfunction, and increase inflammation. Epidemiological studies show an association between vitamin D deficiency and risk factors for cardiovascular disease, but a causal relationship has not been established. The high cardiovascular morbidity and mortality associated with CKD in adults requires therapies to decrease this elevated risk. However, results from several meta-analyses and randomized clinical trials in adults have not shown convincing evidence for the use of vitamin D therapy in improving cardiovascular outcomes. Lack of high-quality evidence from randomized clinical trials in children regarding the effectiveness and long-term safety of vitamin D treatment precludes any recommendations on its use to mitigate the cardiovascular burden of CKD.

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