Vitamin D Therapy in Adults With CKD: A Systematic Review and Meta-analysis.
A large meta-analysis of 128 trials found that vitamin D compounds lower parathyroid hormone but do not reduce the risk of death in chronic kidney disease, with uncertain effects on fractures and heart outcomes and a measurable rise in blood calcium.
Background
Vitamin D compounds are widely used to manage CKD-mineral and bone disorder, but whether they improve patient-level outcomes such as death, cardiovascular events and fractures, rather than just biochemistry, has been uncertain.
Study design
Systematic review and random-effects meta-analysis of randomized controlled trials (MEDLINE, Embase, CENTRAL through February 2023) in adults with CKD stages 3-5 including dialysis, excluding transplant recipients, requiring at least 3 months of follow-up. 128 studies with 11,270 participants were included; evidence certainty was graded with GRADE.
Key findings
Versus placebo, vitamin D probably had no effect on all-cause death (RR 1.04, 95% CI 0.84-1.24), with uncertain effects on fracture (RR 0.68, 0.37-1.23) and cardiovascular death (RR 0.73, 0.31-1.71). Vitamin D lowered PTH and alkaline phosphatase but increased serum calcium. Trials were generally short, small and of suboptimal quality.
Clinical implications
Vitamin D therapy improves CKD-MBD biochemistry but has not been shown to reduce mortality, and may raise calcium. The findings argue for caution about treating to biochemical targets alone and underscore the need for adequately powered outcome trials.
Category
Research
Source
American Journal of Kidney Diseases
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