Inflammation is a major non-nutritional contributor to hypoalbuminemia that is strongly associated with increased morbidity and mortality in stage 5 CKD. In a randomized double-blind clinical trial of vitamin D supplementation in 123 congestive heart failure patients by Schleithoff et al. (Am J Clin Nutr. 2006;83:754-759), anti-inflammatory cytokine interleukin 10 (IL-10) increased significantly in the group receiving 2,000 IU/day of cholecalciferol compared with those receiving none. The authors conclude that study results “indicate vitamin D can serve as an anti-inflammatory agent.”

 


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Studies have linked vitamin D deficiency to an increased risk of CVD, the primary cause of mortality in stage 5 CKD. This increased risk may involve vitamin D receptors (VDRs) in smooth muscle cells and the role of vitamin D in reducing inflammation related to atherosclerosis.

 

A prospective cohort study by Wang et al. (Am J Clin Nutr. 2008;87:1631-1638) examined serum 25(OH)D levels in 230 peritoneal dialysis patients and followed them for three years comparing incidence of cardiovascular events (CVE) to baseline vitamin D. The authors report that low serum 25(OH)D (18.3 ng/mL or less) was associated with an increased risk of CVE.

 

Furthermore, in a nested case-control study of 18,225 men in the Health Professionals Follow-up Study, Giovannucci et al. (Arch Intern Med. 2008;168:1174-1180) looked at MI risk associated with serum 25(OH)D levels and concluded that “low levels of 25(OH)D are associated with higher risk of myocardial infarction in a graded manner, even after controlling for factors known to be associated with coronary artery disease.”

 

As new evidence emerges regarding the importance of vitamin D for “non-bone” functions, it is hoped that renal research will focus on the potential benefits of regularly monitoring serum 25(OH)D and supplementing as needed to maintain adequate levels in CKD patients.