Continue Learning About Kidney Disease
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.
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How Does The Body Process Vitamin D
Image from: Vuolo, L., Di Somma, C., Faggiano, A. & Colao, A. . Vitamin D and cancer. Front Endocrinol, 3, 1-13.
Vitamin D that comes from our skin, our diet or supplements needs to be switched on or converted into the active form that the body can actually use which is a process that involves both the liver and the kidneys.
The first step occurs in the liver where cholecalciferol or ergocalciferol is converted to 25-hydroxyvitamin D2 also known as calcidiol.
The second step happens in the kidneys where 25-hydroxyvitamin D2 is converted into 1,25-dihydroxyvitamin D3 also known as calcitriol which is the physiologically active form of vitamin D which just means that its the form that vitamin D has to be in to exert its effects on the body.
This final process largely takes place in the kidneys however some other cells in the body do have the ability to activate vitamin D in smaller amounts.
Vitamin E And Diabetic Kidney Disease
Vitamin E has also been shown to be of benefit for people with diabetic kidney disease.
Since oxidative stress and inflammation have demonstrated a significant role in the development and progression of diabetic kidney disease, a number of studies have shown that vitamin E can reduce albuminuria and improve renal function in diabetic kidney disease.
A recent study was conducted on people with stage 3 diabetic kidney disease. One group was given 400mg of tocotrienol-rich vitamin E a day and the other group were given a placebo. The group given the vitamin E supplement had significantly improved kidney function throughout the study period as shown by a decrease in creatinine and an increase in eGFR.
Some other benefits of vitamin E for people with CKD include:
- Alleviation of muscle cramps during haemodialysis
- Improvement of anaemia in patients on dialysis
- Reduction of EPO requirements
- Reduction in contrast medium-induced acute kidney injury
- Protects against heavy metal-induced injury
- Helps to protect the kidneys from damage caused by loss of blood supply
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Which Supplements Will I Need To Take
Depending on your health and other factors, your healthcare provider may recommend some of the following supplements:
- B Complex: B complex vitamins are grouped together, but each has a different job to do.
- One of the important functions of vitamin B6, B12 and folic acid is to work together with iron to prevent anemia. If you have anemia, it means you do not have enough red blood cells. Red blood cells carry oxygen from your lungs to all parts of your body.
- Additional B vitamins, called thiamine, riboflavin, pantothenic acid and niacin, can also be given as a supplement. These vitamins help to change the foods you eat into energy your body can use.
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Vitamin D: Can You Have Too Much Of A Good Thing In Chronic Kidney Disease
- Howard A. MorrisCorrespondenceSchool of Pharmacy and Medical Science University of South Australia, North Terrace Adelaide South Australia 5000 AustraliaSchool of Pharmacy and Medical Science, University of South Australia Adelaide South Australia AustraliaChemical Pathology, SA Pathology Adelaide, South Australia, Australia
Clin J Am Soc Nephrol.Kidney Int.
Clin Biochem Rev.
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Talk To Your Doctor Before Taking Any Over
Because CKD can change the way your body processes certain substances, its important to talk to your doctor about any over-the-counter medication, vitamins, or supplements that youre takingwhether its something new or something youve been taking regularly. Certain medications and even herbal substances can be harmful at any stage of CKD. Talking to your doctor can help ensure that youre protecting your kidney health.
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Benefits That Come From Kidney Disease Solution
With this program, here are the benefits you could expect to see with your kidneys and health:
- An integrated and comprehensive treatment for kidney disease.
- A natural treatment method that does not rely on drugs, supplements or any other methods.
- Lowering kidney load and relieving the build-up of toxin in the kidneys
- Improved overall health through simple lifestyle modifications
- Better diet through understanding the best foods to eat and what you should avoid to ensure healthy kidneys
- Reduced stress and improved sleep by guided yoga and meditation exercises
- Greater energy throughout the day
Vitamin E As An Antioxidant And Anti
Ok, so back to vitamin E. As an antioxidant, vitamin E can help to reduce some of the damage caused by the oxidative stress and inflammation that is present in people with CKD. Studies have shown that when people with CKD were supplemented with vitamin E, markers of oxidative stress were reduced, and antioxidant status was significantly improved.
As well as being an antioxidant, vitamin E also has anti-inflammatory actions. Like oxidative stress, inflammation also contributes to the development and progression of CKD as well as other diseases such as diabetes and cardiovascular disease.
In a meta-analysis of 11 randomised controlled trials in patients receiving haemodialysis, supplementation with vitamin E was shown to significantly reduce MDA which is a marker of oxidative stress and reduced CRP which is a marker of inflammation in the body. Elevated CRP levels are associated with progression of CKD AND with risk for cardiovascular disease and cardiovascular events such as heart attack, stroke and sudden cardiac death.
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Vitd As A Predictive And Prognostic Biomarker
In current clinical practice, most assays estimate total 25D, which cannot distinguish the three different forms of 25D . This approach has many limitations since there are many variables that are influenced by physiologic and pathophysiologic conditions. The VDBP’s affinity is affected by both hyperlipemic conditions and the three common variants of VDBP’s gene, GC1F , GC1S, and GC2 . Many efforts were made at inventing new assays that can directly, validly, efficiently, affordably, and quickly estimate free 25D, rather than calculating it using already-existing multi-factorial formulas. Free 25D measurement is considered to have more benefits than total 25D. So far, the studies have only proved the benefits of free 25D in cases with differences in VDBP affinity, in the elderly, in pregnancy to detect VitD deficiency, in liver diseases, in kidney disorders , in acromegaly, and in allergies associated with atopy and pulmonary function in asthmatic children . However, in many studies, no significant superiority of free 25D was observed. Still, there were many limitations in some of the studies, due to sample size and due to the use of monoclonal VDBP kits in multiracial/non-Caucasian populations, which affected the outcome .
Regarding the predictive and prognostic role of VitD and its metabolites, mostly 25D but, also, 1,252D can act as novel biomarkers of AKI .
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Control Your Blood Sugar:
People with high blood sugar are at greater risk of developing kidney damage because their kidneys have to work extra hard to filter the excess sugar from their blood. Over time, this extra strain may lead to serious kidney damage before you can say what vitamins are good for kidneys, but its easy to prevent or reverse if you can catch it early on.
Exercise And Kidney Health
Research has demonstrated several benefits of physical activity for individuals with CKD. A recent meta-analysis found that aerobic exercise is associated with improved cardiorespiratory function, exercise duration, high-density lipoprotein cholesterol levels, and quality of life in patients with CKD. Physical activity can also contribute to prevention by improving metabolic risk factors, which may protect kidney function.
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How Do I Know If Im Not Getting Enough Vitamins And Minerals
Almost all vitamins and minerals come from the foods you eat. Your body cannot make these substances. People with healthy kidneys who eat a variety of foods from all the food groups can get enough vitamins and minerals. But if you have chronic kidney disease or are on dialysis, your diet may limit some food groups. Therefore, you may not be getting all the vitamins and minerals you need each day, so you may need to take some in the form of supplements. Your healthcare professional and kidney dietitian can help you find out which vitamins and minerals you may need by looking at your health history and blood tests.
Rcts: With Calcitriol And Vitamin D Analogues
The active form of vitamin D and its analogues used in the treatment of CKD patients include calcitriol and the vitamin D analogues paricalcitol 2D2) and the 1,252D precursor alfacalcidol D3) . 1,252D3 is identical to the endogenous activated form of calcifediol D3). Paricalcitol and alfacalcidol, the latter of which requires hepatic hydroxylation at the 25 position, are synthetic analogues of vitamin D and are also referred to as vitamin D receptor activators . VDRAs have been used for the management of SHPT in CKD patients for a few decades and show to have reno-protective properties such as reducing albuminuria, renal damage and dysfunction . Paricalcitol suppresses PTH secretion whilst it has a lower stimulatory effect on intestinal absorption of calcium and phosphate compared to 1,252D . Paricalcitol is also associated with reduction of cardiovascular events , although sufficient studies with CKD patients are still lacking.
All twelve studies included CKD patients G34, however, there were differences between studies in patient characteristics. For example, diabetes, established SHPT, use of phosphate binders and proteinuria. The duration of administration varied from 2 to 48 weeks and the dosages used in these studies from 0.25 to 2 g.
All four studies that measured either alkaline phosphatase or bone specific after paricalcitol treatment reported a decrease in this marker of bone metabolism.
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Use Of Vitamin D Drops Leading To Kidney Failure In A 54
Vitamin D toxicity is rare, but clinicians must be aware of the risks of vitamin D use to limit complications related to hypercalcemia.
Calcium levels may get worse before getting better in patients even after cessation of supplements, as vitamin D is fat soluble.
Observational data and expert opinion suggest that glucocorticoids, ketoconazole and hydroxychloroquine are reasonable options to treat hypercalcemia related to vitamin D toxicity by decreasing the active 1, 25 dihydroxyvitamin D3 levels.
A 54-year-old man was referred urgently to the nephrology clinic by his family physician for suspected acute kidney injury, with a creatinine level of 376 mol/L. He had recently returned from a trip to Southeast Asia, where he had spent extensive periods sunbathing for 2 weeks. His medical history included hypertension, dyslipidemia and gout, for which he was taking perindopril 8 mg daily, rosuvastatin 10 mg daily, amlodipine 10 mg daily, indapamide 2.5 mg daily and febuxostat 80 mg daily.
The patients family history included autosomal dominant polycystic kidney disease, with 2 first-degree relatives requiring dialysis before age 60. However, he had undergone radiographic screening with abdominal ultrasonography, which was negative for polycystic kidneys.
Box 1: Relevant serum laboratory values across the patients initial and most recent clinic visits over a 10-month period, with hydroxychloroquine started after his second clinic visit*
Vitamin D Toxicity Induced Aki
VitD-mediated hypercalcemia can be due to: excessive VitD2 or D3 ingestion/supplementation, extravagant calcitriol ingestion or pharmaceutical administration, elevated ectopic production of calcitriol , milk-alkali syndrome , and depleted catabolism of calcitriol due to mutations of CYP24A1 genes .
VitD toxicity due to immoderate administration of VitD supplements or overfortified milk is a global phenomenon , potentially affecting kidney function. Chowdry et al. presented a study of VitD toxicity incidents in a tertiary care center at the Sher-i-Kashmir Institute of Medical Sciences, in which 16 out of 19 patients where identified with hypervitaminosis Dinduced AKI due to extravagant doses of VitD , in order to correct VitD deficiency. Not all the patients with toxic levels of 25D developed symptoms . Similarly, 13 patients in Brazil developed AKI due to intramuscular injection of veterinary supplements of vitamins A, D, and E for esthetic purposes .
Also, VitD toxicityinduced AKI has been observed due to anabolic steroid and VitD supplement abuse , dispensing errors , dosage malpractice and overcorrection of VitD deficiency , intramuscular injection of VitD after operation , overfortification of milk with VitD , over-the-counter supplements , and topical treatment with calcitriol analog in combination with oral calcium/VitD for psoriasis .
Table 3. Cases of hypervitaminosis D as cause of AKI.
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The Role Of Vitamin D In Kidney Disease
Vitamin D deficiency is the most common nutrient deficiency in the world and is particularly common in people with kidney disease. Add to that the fact that vitamin D deficiency is linked to progression of kidney disease and increased risk of mortality and I think we have a few pretty good reasons to explore the role vitamin D and the importance of maintaining optimal vitamin D levels.
Interestingly enough, vitamin D is completely different than any other vitamins. In fact, its not really a vitamin at all! Vitamin D is actually a prohormone- a nutrient that converts into a hormone within the body.
Being a fat-soluble vitamin, vitamin D is stored in the body in fat cells which can be accessed as needed.
What Are Vitamins And Minerals
Vitamins and minerals are substances your body needs to help carry out important functions. They work to help your body get energy from the foods you eat, help repair tissue, and help maintain life. Therefore, they are essential for your body. But if you have kidney disease or are on dialysis, you may not be getting enough.
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Effects Of Therapy With Ergocalciferol
Zisman et al. evaluated the current therapeutic guidelines to raise 25-hydroxyvitamin D by the administration of ergocalciferol. These investigators showed that in 52 patients with stages 3 and 4 CKD, the concentration of 25-hydroxyvitamin D could be raised slightly above 30 ng/ml, and such therapy was associated with a relatively small decrease in the levels of intact PTH, only in the patients with stage 3 CKD and not in those with stage 4 CKD. Chandra et al. evaluated cholecalciferol therapy, 50,000 U/wk for 12 wk, in a randomized, controlled trial of stages 3 and 4 CKD and successfully raised the geometric mean value for 25-hydroxyvitamin D to almost 50 ng/ml and showed a 31% decrease in PTH in the treated group compared with 7% decrease in the placebo group, but this was NS because of high variability in PTH values.
London et al. evaluated 52 patients who were on hemodialysis in a cross-sectional study for possible relationships of aortic stiffness, brachial artery distensibility, and arterial calcification scores with 25D3 and 1,252D3 serum levels. These investigators noted that these values were negatively correlated with aortic pulse wave velocity and positively correlated with brachial artery distensibility and flow-mediated dilation. Whether vitamin D supplementation will improve arteriosclerosis and endothelial dysfunction in patients who are on hemodialysis needs to be further evaluated in the future .
Certain Herbal Supplements And Vitamins
Its important to consult with your doctor before taking any supplements, especially if you are living with chronic disease. Surprising to most, it is not recommended to take some types of herbal supplements and vitamins if youre living with diabetic kidney disease. Certain herbal supplements and vitamins can actually cause further damage to your kidneys. Herbal supplements that your healthcare provider may recommend avoiding include parsley root, astragalus, creatine, licorice root and stinging nettle, but there are many more. Vitamins to limit with DKD include vitamins A, E and K, as these vitamins may accumulate and damage the kidneys.
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