New guidelines and research studies have emphasized the untangling knotty problems associated with vitamin D supplementation. This is particularly crucial for people living with chronic kidney disease (CKD) and prediabetes. A new meta-analysis conducted by Dr. Daniel Weiner shows some of those results. In adults with prediabetes, higher doses of vitamin D can lower the progression to diabetes by 15%. For many effects of vitamin D on other health outcomes, it’s still unclear whether it’s beneficial, particularly for those with more advanced CKD.
The latest Endocrine Society Clinical Practice Guideline – 2024 – recommends a cautious approach to vitamin D therapy. This suggests that this treatment likely does not have a meaningful impact on all-cause mortality or fracture risk of patients with chronic kidney disease (CKD). Fourth, it underscores the importance of tailoring treatment plans to specific populations instead of a one-size-fits-all approach. This growing understanding further emphasizes the importance that personalized medicine plays in vitamin D management. It matters for patients with various acute and chronic health needs.
Meta-Analysis Findings
Their latest meta-analysis showed results from 128 studies with 11,270 patients, with vitamin D versus placebo and other formulations. These trials were conducted mainly on adults with high-risk prediabetes, using dosages of 850 IU to 7500 IU.
Dr. Weiner added that the average vitamin D supplementation estimated daily dose was about 3500 IU. He praised vitamin D therapy for its positive effect in reducing diabetes risk. Previous research, he said, didn’t just demonstrate a lower likelihood of progression to diabetes, but vitamin D increases the likelihood of reverting back to normal glucose regulation.
The systematic review and meta‐analysis found limited evidence associating vitamin D with reduced mortality in CKD patients. This obvious lack of strong support should raise serious questions about the nutrient’s effectiveness. According to lead author Dr. Weiner, “These results clearly demonstrate that neither nutritional vitamin D nor activated vitamin D has produced a mortality benefit for the CKD population. The notion that vitamin D supplementation improves survival is unfounded.”
The guidelines further indicated that vitamin D therapy had uncertain effects on fracture rates and cardiovascular death among patients with advanced CKD.
Individualized Treatment Approaches
The updated 2024 Endocrine Society clinical practice guidelines support a more individualized approach to vitamin D therapy. This shift is especially critical given that most patients with CKD stages G3a-G5 are not on dialysis. Their recommendations advise against routine use of calcitriol and vitamin D analogs in these patients.
Anastassios G. Pittas, MD, chief of the Division of Endocrinology at Tufts Medical Center, reiterated the need for individualized care. He further explained, “In other words, a one-size-fits-all practice is not as effective as a thoughtful, individualized approach — particularly as 25(OH)D thresholds can differ between populations.” Sending all otherwise healthy CKD patients for routine testing of vitamin D levels is unnecessary, Dr. Pittas added.
He highlighted the complexity surrounding vitamin D supplementation: “There is the pill burden to think about with CKD patients,” suggesting that clinicians should prioritize medications with more significant benefits for renal health. Instead, I’d rather have them add in one other pill — either for blood pressure or SGLT2 for that reason. These common-sense options are proven to do more than anything to save lives and prevent a tragedy.
Current Guidelines and Recommendations
Current guidelines suggest checking 25(OH)D levels in patients with CKD stages G3a to G5. Further testing will be guided by the baseline measurements and any treatment being undertaken. This recommendation is consistent with the recommendations of the Kidney Disease Improving Global Outcomes (KDIGO). This means that caution needs to be exercised with vitamin D supplementation in this population, they warn.
The 2024 Endocrine Society clinical practice guidelines emphasize activated vitamin D therapy’s strong efficacy for reducing parathyroid hormone (PTH) levels and increasing serum calcium levels. They stress the absence of rigorous data backing routine supplementation. The guidelines state: “For adults with high-risk prediabetes, in addition to lifestyle modification, we suggest empiric vitamin D supplementation to reduce the risk of progression to diabetes.”
Dr. Pittas warned against relying too heavily on observational studies to determine what vitamin D can and cannot do. He explained that confounding is a big problem in studies examining the effects of vitamin D. He stressed the need for consensus standards for appropriate thresholds across populations and outcomes.
“Just because you can measure vitamin D and raise the level doesn’t mean your patients will feel any better.” – Anastassios G. Pittas
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