Avoid vitamin D ‘mega-doses’ for patients with CKD, kidney transplant
Key takeaways:
- The report recommends patients avoid vitamin D doses beyond 100,000 IU.
- Researchers also advise limiting 25-hydroxyvitamin D levels to below 150 nto 200 nmol/L.
Patients with chronic kidney disease and those who have had a kidney transplant should avoid high doses of vitamin D, according to an evidence-based consensus document.
“Vitamin D deficiency is common in patients with CKD and associates with poor outcomes,” Hanne Skou Jørgensen, MD, PhD, associate professor in the department of clinical medicine at Aarhus University in Denmark, wrote with colleagues. “Even so, the evaluation and management of vitamin D deficiency in patients with CKD remains controversial.”
Supplementation with active vitamin D compounds may not improve outcomes and may increase hypercalcemia risk for patients with CKD, the researchers wrote. “Current clinical practice guidelines state that it is reasonable to reserve the use of calcitriol and active vitamin D analogues for patients with advanced CKD and severe and progressive hyperparathyroidism.”
A joint panel from the European Renal Osteodystrophy arm of the European Renal Association and the European Society for Paediatric Nephrology ran a comprehensive literature review to form clinical practice points on vitamin D use by patients with kidney disease.
“This consensus statement addresses questions and aims to provide guidance on how to monitor for and correct vitamin D deficiency using nutritional vitamin D supplements in children and adults with CKD, on dialysis and after kidney transplantation,” they wrote.
Results from a Delphi survey among the panel indicated high overall agreement on the clinical practice points, with 80% to 90% agreement on all but three recommendations.
Key among the guidelines is steering clear of vitamin D “mega-doses” beyond 100,000 IU and limiting 25-hydroxyvitamin D levels to below 150 nmol/L to 200 nmol/L (60 ng/mL to 80 ng/mL) to reduce toxicity risk, the researchers wrote. Providers can monitor vitamin D deficiency, targeting serum 25-hydroxyvitamin D levels above 75 nmol/L (30 ng/mL).
In cases of hypercalcemia, the consensus suggests exploring and managing other potential causes of high calcium, such as iatrogenic factors from the use of active vitamin D compounds or dietary calcium, as well as CKD- and non-CKD-related conditions.
“Future research should focus on (pragmatic) clinical trials investigating the benefit of vitamin D supplementation on patient-relevant outcomes in the setting of vitamin D deficiency, across the spectrum of CKD,” the researchers wrote.
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