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16 September 2021
Bover et al. (2021) have recently published a meta-analysis of randomised controlled trials (RCTs) investigating the effects of nutritional vitamin D (NVD) supplements on 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) in non-dialysis chronic kidney disease (ND-CKD). Using a novel dual analysis approach, the study shines a new light on the underlying mechanisms of vitamin D supplementation in ND-CKD.1
The aim of this study was to evaluate the effectiveness of NVD to raise vitamin D and actively lower PTH in ND-CKD patients with secondary hyperparathyroidism (SHPT).1
Bover et al. conducted a systematic literature review in PubMed to identify 14 RCTs that evaluated one or both of the NVD supplements, ergocalciferol or cholecalciferol, and had a study population of at least 20 adult (>18 years) patients with documented ND-CKD.1 The main results extracted from the studies were changes in absolute values of 25(OH)D, PTH, calcium, phosphate and fibroblast growth factor-23 (FGF-23) from start to end of the study periods.1 Fixed and random effects models were used to pool study-level results and the effects were studied within NVD study arms and relative to control groups (placebo/no treatment).1
Quality of evidence
The evidence was low to moderate in quality due to the number of studies available for inclusion and heterogeneity in study results:1
Pooled 25(OH)D level increases
NVD supplementation increased levels of 25(OH)D in both analyses:1
Average levels of 25(OH)D in the NVD study arms at the end of the study period:1
Pooled PTH level reductions
Reductions in PTH were observed in both analyses:1
Changes in calcium, phosphate and FGF-23
While small and statistically non-significant changes in phosphate and FGF-23 were observed, NVD supplementation caused calcium levels to significantly increase when compared with placebo/no treatment (increase: 0.23 mg/dL).1
You can read the full article published by Bover et al. on the Clinical Kidney Journal website.
Footnotes and references
*From the fixed effects model.1
1. Bover J et al. Clin Kidney J. 2021;sfab035.
2. Strugnell SA et al. Am J Nephrol. 2019;49:284–93.
3. Ennis JL et al. J Nephrol. 2016;29(1):63–70.
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