The immunoregulatory function of vitamin D: implications in chronic kidney disease.

Abstract

Cardiovascular and infectious diseases remain the most common causes of death among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Basic science and epidemiological studies indicate that vitamin D has importance not only for cardiovascular health, but also for the immune response. Vitamin D signaling pathways regulate both innate and adaptive immunity, maintaining the associated inflammatory response within physiological limits. Levels of both the inactive as well as active form of vitamin D (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, respectively) are decreased in patients with CKD and ESRD. It is reasonable to hypothesize, therefore, that the immune dysfunction associated with vitamin D deficiency in patients with CKD and ESRD in part explains the misdirected inflammatory response and increased susceptibility to infection seen in this population. Indeed, observational studies show that vitamin D deficiency in patients with ESRD is associated with increased mortality, and treatment with vitamin D is associated with a decreased risk of infection, as well as reduced all-cause mortality. However, whether different vitamin D preparations have differential effects on physiological function and clinical outcomes is still unclear. A proper understanding of the immune regulatory function of vitamin D is important for the development of future therapeutic strategies.

• Authors: Kevin A Sterling, Parham Eftekhari, Matthias Girndt, Paul L Kimmel, Dominic S Raj
• Journal: Nature reviews. Nephrology (Nat Rev Nephrol) Vol. 8 Issue 7 Pg. 403-12 (May 22 2012) ISSN: 1759-507X [Electronic] England
• PMID: 22614789 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Review)

Chemical References

• Vitamin D

Topics

• Humans
• Renal Insufficiency, Chronic (immunology, metabolism, mortality)
• Risk Factors
• Signal Transduction (immunology)
• Vitamin D (immunology, metabolism)
• Vitamin D Deficiency (immunology, metabolism, mortality)