Vitamin D therapy of no benefit in CKD

For patients with chronic kidney disease (CKD), vitamin D therapy does not appear to lower the risk of death, with uncertain effects on fracture and cardiovascular and kidney outcomes, according to the results of a meta-analysis.

Researchers conducted a systematic review of randomized controlled trials (RCT) with ≥3 months of follow-up, during which a vitamin D compound was evaluated in adult patients with stage 3, 4, or 5 CKD, including kidney failure treated with dialysis.

Random effects meta-analysis was used to summarize treatment estimates. Primary endpoints were all-cause death, cardiovascular death, and fracture. Secondary endpoints included major adverse cardiovascular events (MACE), hospitalization, bone mineral density, parathyroidectomy, progression to kidney failure, proteinuria, estimated glomerular filtration rate, hypercalcaemia, hyperphosphatemia, biochemical markers of CKD-mineral bone disease (MBD), and various intermediate outcome measures of cardiovascular disease.

The meta-analysis included 128 studies, which comprised 11,270 participants. Pooled data showed that compared with placebo, vitamin D therapy seemed to have no effect on all-cause death (relative risk [RR], 1.04, 95 percent confidence interval [CI], 0.84–1.24) and have uncertain effects on fracture (RR, 0.68, 95 percent CI, 0.37–1.23) and cardiovascular death (RR, 0.73, 95 percent CI, 0.31–1.71).

Vitamin D therapy was associated with lowered serum parathyroid hormone and alkaline phosphatase but increased serum calcium relative to placebo.

The present analysis was limited by the inclusion of trials with short-term follow-up periods, small sample size, and suboptimal quality.