Shining d' light on chronic kidney disease: Mechanisms that may underpin the cardiovascular benefit of vitamin D

Abstract

Hypovitaminosis D is a significant health-care burden worldwide, particularly in susceptible populations such as those with chronic kidney disease (CKD). Recent epidemiological studies have identified that both higher serum vitamin D concentrations and use of vitamin D supplements may confer a survival benefit both in terms of all-cause and cardiovascular mortality. There is potential to investigate this inexpensive therapy for the CKD population, which suffers excessive cardiovascular events, although the mechanisms explaining this link have yet to be fully elucidated. This review discusses potential mechanisms identified in the basic science literature that may provide important insights into how vitamin D may orchestrate a change in cardiovascular risk profile through such diverse mechanisms as inflammation, atherogenesis, glucose homeostasis, vascular calcification, renin-angiotensin regulation and alterations in cardiac physiology. Where available, the clinical translation of these concepts to intervention trials in the CKD population will be reviewed. Substantial epidemiological and experimental evidence suggests low vitamin D levels could be one of the factors that might explain increased cardiovascular risk in the chronic kidney disease population. In this issue, Petchey et al. perform a critical and comprehensive review of the currently available data, which will be an essential pre-requisite for the design a prospective clinical trials in this area, in the future. © 2011 Asian Pacific Society of Nephrology.