Vitamin D deficiency and infection in chronic kidney disease

Abstract

Infections are an important cause of morbidity and mortality in chronic, particularly end stage, renal disease. Uremia and dialysis are associated with immune impairment at multiple levels: decreased innate and adaptive immunity, increased inflammation. The role of vitamin D in the regulation of immune functions, particularly as an enhancer of innate immunity and as an anti-inflammatory agent, is now well recognized. Since vitamin D deficiency is frequent in patients with chronic kidney disease, several studies examined the relationships between vitamin D insufficiency and immune impairment or infectious diseases in this population. Vitamin D deficiency could contribute to decreased innate immunity and increased inflammation or immune cell activation, including through modulating the microbiome and intestinal permeability. Convincing data from epidemiological studies have associated vitamin D deficiency with inflammation, all-cause mortality, cardiovascular and infectious outcomes. However, intervention studies are still needed to validate the causality relationship and determine whether vitamin D supplementation can reduce infections in chronic kidney disease patient.