Vitamin D Management in Chronic Kidney Disease: A Comprehensive Guide

Chronic kidney disease (CKD) causes disorders of mineral and bone metabolism. Abnormalities of vitamin D are common in CKD. The other common minerals and hormones affected are calcium, phosphorus and parathyroid hormone (PTH). Reduced kidney function leads to decreased phosphorus excretion, which then causes decreased vitamin D and calcium absorption. This causes the parathyroid hormone levels to rise. All these metabolic abnormalities, if allowed to exist, can lead to bone abnormalities, fractures, calcification of the skeleton, heart disease and even death, according to the Kidney Disease: Improving Global Outcomes website. Doctors focus on managing levels of minerals and hormones to reduce the risk of bone disease in CKD.

Instructions

Vitamin D Treatment Depends on Phosphorus, Calcium and PTH.

• 1

  Vitamin D levels in kidney disease

  Test your levels of vitamin D, especially if you have mid to late kidney disease, by requesting a blood test from your doctor. (See reference 1, guideline 3.1.3.) Vitamin D prevents bones from becoming weak or malformed in CKD.

• 2

  Vitamin D supplement

  Tests your levels of phosphorus calcium and PTH if you have low levels of vitamin D. Depending on how much kidney function you have, your doctor may get you to take a vitamin D supplement or try to elevate your levels of calcium and phosphorus to increase your levels of vitamin D. Keeping levels of vitamin D, phosphorus, calcium and PTH within normal range may slow down the loss of kidney function. (See reference 1, guidelines 4.1 and 4.2.)

• 3

  Tell your doctor if you are taking vitamin D

  Tell your doctor or dietitian if you have taken vitamin D. Taking vitamin D on your own may adversely affect levels of phosphorus, calcium and PTH. All these minerals and hormones depend on each other and very high levels of any of them can cause severe consequences. (See reference 1, guidelines 4.1 and 4.2.)

• 4

  Sunshine is one source of vitamin D

  Find out what type of vitamin D is right for you. You usually get vitamin D from the sun and your kidneys convert inactive vitamin D to an active type your body can use. If you kidneys are damaged, this process will not work as well as it should, and you may have to take an active form of vitamin D. If you have low levels of vitamin D, get your doctor to tell you what type of vitamin D you need. (See reference 2.)

• 5

  Fatty fish is a good source for vitamin D

  Find the best food sources for vitamin D. High levels of vitamin D are found in fatty fish including salmon, sardines, cod, tuna and halibut. Beef liver, cheese, and egg yolks contain small amounts of vitamin D. Many foods, such as some breakfast cereals and milk, are fortified with vitamin D, but the natural food sources are always better. Ask your dietitian to figure out what types of foods are right for you. (See reference 2.)

• 6

  Find a renal dietitian if you can

  Find a renal dietitian. They are experts on CKD. The treatment of vitamin D in CKD is very complicated and challenging. The food you eat, when you have CKD and bone disease, can really help you get better or worse. (See reference 3.)