Abstract
Cardiovascular and infectious diseases remain the most common causes of death among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Basic science and epidemiological studies indicate that vitamin D has importance not only for cardiovascular health, but also for the immune response. Vitamin D signaling pathways regulate both innate and adaptive immunity, maintaining the associated inflammatory response within physiological limits. Levels of both the inactive as well as active form of vitamin D (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, respectively) are decreased in patients with CKD and ESRD. It is reasonable to hypothesize, therefore, that the immune dysfunction associated with vitamin D deficiency in patients with CKD and ESRD in part explains the misdirected inflammatory response and increased susceptibility to infection seen in this population. Indeed, observational studies show that vitamin D deficiency in patients with ESRD is associated with increased mortality, and treatment with vitamin D is associated with a decreased risk of infection, as well as reduced all-cause mortality. However, whether different vitamin D preparations have differential effects on physiological function and clinical outcomes is still unclear. A proper understanding of the immune regulatory function of vitamin D is important for the development of future therapeutic strategies.
Key Points
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Vitamin D has functions other than its role in calcium and phosphorus homeostasis
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Vitamin D regulates both the innate and adaptive immune response
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Cathelicidin, an antimicrobial peptide, is transcriptionally regulated by vitamin D
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Patients with chronic kidney disease and end-stage renal disease have decreased levels of both the inactive and active forms of vitamin D
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Vitamin D deficiency could contribute to the immune dysfunction observed in patients with chronic kidney disease
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This work is supported in part by NIH grant R01 DK073665-01A1 awarded to D. S. Raj.
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Sterling, K., Eftekhari, P., Girndt, M. et al. The immunoregulatory function of vitamin D: implications in chronic kidney disease. Nat Rev Nephrol 8, 403–412 (2012). https://doi.org/10.1038/nrneph.2012.93
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DOI: https://doi.org/10.1038/nrneph.2012.93
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