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Watch the debate about optimal vitamin D targets in CKD and SHPT

1 May 2020

Do ND-CKD patients with SHPT need a higher level of vitamin D compared with the general population?

Explore both sides of this important question by watching ‘The vitamin D debate in CKD and SHPT: how high should we aim?’

What's the debate about?

Held at the 2019 American Society of Nephrology (ASN) Kidney Week, Washington, DC, the debate on the optimal vitamin D target in non-dialysis chronic kidney disease (ND-CKD) patients with secondary hyperparathyroidism (SHPT) focuses on answering three important questions:

  1. Do patients with ND-CKD need a higher level of vitamin D compared with the general population?
  2. If so, is the higher level necessary to manage SHPT?
  3. What is the best way to give vitamin D to ND-CKD patients?

The event begins with an introduction by Michal Melamed, Associate Professor at the Albert Einstein College of Medicine, New York, who lays the foundation for the debate by presenting background information about CKD, SHPT and vitamin D therapy.

This is followed by a presentation by James B Wetmore, Associate Professor at the University of Kansas, Kansas, who argues that a higher vitamin D level is needed to manage SHPT in ND-CKD patients. He highlights that the current target 25D level is based on the general population; however, ND-CKD patients may not be able to achieve this without treatment because the physiology of their parathyroid glands is altered. To support this, Associate Professor Wetmore points to the association between low glomerular filtration rate (GFR) and the proportion of patients with 25D levels lower than 37.4 nmol/L (15 ng/mL).

The arguments posited by Associate Professor Wetmore are then countered in a presentation by Julia Scialla, Associate Professor at the University of Virginia, Virginia, who believes that a lower vitamin D level is better than a higher level for ND-CKD patients. She argues that, in line with current guidelines, vitamin D should be used to reduce the burden of SHPT without increasing the risks of other complications, and no significant benefit of a higher 25D level on PTH levels, bone disease or fractures has been observed. Associate Professor Scialla suggests that higher vitamin D levels could help to treat SHPT in ND-CKD patients, but only in special cases.

Both Wetmore and Scialla then engaged in a lively discussion, with questions from the audience.

The debate, which was sponsored by OPKO Pharmaceuticals, LLC, is now available on the ASN website for all to benefit. Watch it right now and get the latest understanding of optimal vitamin D targets in ND-CKD patients with SHPT.