PracticeUpdate Conference Series ISN WCN 2019

Effects of Vitamin D Uncertain in Patients with Chronic Kidney Disease Meta-analysis revealed no effect on fracture, mortality or cardiovascular risk. T he benefits of vitamin D compound supplementation in patients with chronic kidney disease are uncertain,

(BMD), and biochemical markers of chronic kidney disease mineral and bone disorder. The research team identified 109 randomized, controlled trials involving 8935 patients with chronic kidney disease (stages 3 to 5D) that had ≥3 months follow-up and that compared a vitamin D compound (nutritional or active) with a placebo, no study medication, or an active medication. The mean age of participants was 57.1 years, with a median follow-up time of 6 months. Of the 109 trials, 68 were conducted in 4889 dialysis patients and 41 in 4046 non-dialysis patients. The trials were generally at a high or unclear risk of bias, the researchers noted in their abstract. There were no significant differences in the risks of fracture (six trials, risk ratio 0.74, 95% CI 0.20–2.77), mortality (20 trials, risk ratio 1.30, 95% CI 0.78–2.16), or major adverse cardiovascular events (11 trials, risk ratio 0.51, 95% CI 0.21–1.23) between vitamin D and placebo. There were only three studies that specifically examined BMD, and the data were not sufficient to conduct a meta-analysis. In comparison to placebo, vitamin D therapy significantly reduced serum parathyroid hormone levels (nutri- tional: weighted mean difference –4.28 pmol/L, 95% CI –5.73 to –2.83; active: –10.10 pmol/L, 95% CI –14.22 to –5.99). Active vitamin D compounds were found to increase serum calcium as compared to placebo (standardized mean difference 0.86, 95% CI 0.32–1.40) and phosphate levels (weighted mean difference 0.08 mmol/L; 95% CI 0.01– 0.16 mmol/L). Active vitamin D compounds also increased the risk of hypercalcemia (risk ratio 2.46; 95% CI 1.70–3.57), but this was not the case with nutritional vitamin D (risk ratio 0.91; 95% CI 0.48–1.75). “The effects of vitamin D compounds on fractures, mortality and BMD in chronic kidney disease patients are uncertain," concluded the authors in their abstract. “Active vitamin D use led to a greater reduction in serum [parathyroid hormone] levels than nutritional vitamin D, but also increased the risk of hypercalcemia.”

according to a meta-analysis presented at WCN 2019. No benefits were seen with respect to fractures, mortality or cardiovascular risks, and while levels of parathyroid hormone decreased with active vitamin D use, the risk of hyper- calcemia increased. Mineral and bone disorder in chronic kidney disease occurs when damaged kidneys and abnormal hormone lev- els cause calcium and phosphorus to become out of balance. The disorder is characterized by vitamin D deficiency, elevated parathyroid hormone levels, reduced bone quality, and an increased risk of fracture. Vitamin D therapy is a standard component of the ongoing management of the disorder. In this study, presented by Wing C. Yeung, MBBS, of St. George Hospital in Sydney, a systematic review was performed to study the effects of vitamin D therapy on fractures, mortality, bone mineral density

" Active vitamin D use led to a greater reduction in serum [parathyroid hormone] levels than nutritional vitamin D, but also increased the risk of hypercalcemia. "

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PRACTICEUPDATE CONFERENCE SERIES • WCN 2019 20