More than 30 ng of vitamin D is sometimes needed (Kidney needs 50 ng)

Rationale for Raising Current Clinical Practice Guideline Target for Serum 25-Hydroxyvitamin D in Chronic Kidney Disease.

Am J Nephrol. 2019;49(4):284-293. doi: 10.1159/000499187

Participants with Chronic Kidney Disease who had low vitamin D levels Gave extended release vitamin D (in the form of calcifediol) Those who achieved more than 50 ng/ml had much better outcomes It is not clear that the extended release type (patented and very expensive) is needed---* 1 in 10 have Chronic Kidney Disease (but only 5% are aware of it) – review Sept 2019* Poor kidneys rarely get enough or the right form of vitamin D – Feb 2019Previous Vitamin D level conclusions for Kidneys* Hemodialysis associated with very poor mRNA response (wonder if low vitamin D) – March 26, 2021* Chronic Kidney Disease patients need more than 20 ng of Vitamin D – workshop conclusion Oct 2018* [Need at least **80 ng * of vitamin D if have chronic kidney disease – May 2012](/pages/need-at-least-80-ng-of-vitamin-d-if-have-chronic-kidney-disease/) ---Is 50 ng of vitamin D too high, just right, or not enough has the following50 - 60 ng* Vitamin D decreases incidence of disease many charts showing great benefits **40-60 ng* [Need 30-60 ngof vitamin D for good health – Grant Jan 2011](/pages/moved26/)* [USANA 50 ng/ml](/pages/usana-found-5000-iu-resulted-in-50-ng-winter-2010/) with graph* GrassrootsHealth.net 41 experts 40-60 ng/ml * after IoM report* Elite outdoor athletes had 52 ng of vitamin D – March 2013* Vitamin D is needed for human fertility – goal is 50 ng – Sept 2018* Vitamin D - at least 4,000 IU to achieve 40-60 ng and reduce risk of early death – Holick June 2018* Sports benefits from up to 50 ng of Vitamin – meta-analysis - Nov 2012* Need 51 ng to avoid premature ejaculation 2018> 60 ng* [Noticed bones heal faster when **>60 ngof vitamin D](/pages/noticed-bones-heal-faster-when-more-than-60-ng-of-vitamin-d/)* [Need at least 80 ngof vitamin D if have chronic kidney disease – May 2012](/pages/need-at-least-80-ng-of-vitamin-d-if-have-chronic-kidney-disease/) * Many sleep disorders cured with vitamin D levels of 60 to 80 nanograms – May 2012* [Clinical Trial: Colon Cancer and 80-100 ng](http://clinicaltrials.gov/ct2/show/NCT01150877)* Dr. who got patients to vitamin D level of 80 ng - went out of business, patients became too healthy* [Autoimmune diseases such as MS treated/reversed - 150 ngof vitamin D](/pages/update-on-treating-multiple-sclerosis-with-high-dose-vitamin-d/)* Comparing High-dose vitamin D therapies 60-150 ng * --- 1. Kidney category starts with{include}--- 1. Overview Kidney and vitamin D contains the following summary{include}Getting Vitamin D into your blood and cells has the following grapbical summary

CTx-1 = Serum collagen type 1 C-telopeptide

P1NP = Intact procollagen type 1 N-terminal propeptide

Strugnell SA1, Sprague SM2, Ashfaq A3, Petkovich M4, Bishop CW3.

1 Renal Division, OPKO Health, Inc., Miami, Florida, USA, [email protected].

2 Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA.

3 Renal Division, OPKO Health, Inc., Miami, Florida, USA.

4 Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.

BACKGROUND:

Vitamin D repletion is recommended for secondary hyperparathyroidism (SHPT) and associated vitamin D insufficiency (VDI) in chronic kidney disease (CKD), but optimal levels of serum total 25-hydroxyvitamin D remain undefined. Clinical practice guidelines target sufficiency, whereas recent data indicate that higher levels are required to control the elevation of intact parathyroid hormone (iPTH) as CKD advances. This secondary analysis of 2 randomized controlled trials seeks to identify the minimum level of mean serum 25-hydroxyvitamin D required to control SHPT arising from VDI in stage 3 or 4 CKD.

METHODS:

Adult subjects (n = 429) with SHPT, VDI, and stage 3 or 4 CKD were stratified by stage and treated daily with either extended-release calcifediol (ERC) or placebo in 2 identical, parallel, randomized, double-blind studies. After treatment for 26 weeks, all subjects were ranked by the level of serum total 25-hydroxyvitamin D and divided into quintiles in order to examine the relationships between the degree of vitamin D repletion and the associated changes in plasma iPTH, serum bone turnover markers, calcium, phosphorus, intact fibroblast growth factor 23 (FGF23) and vitamin D metabolites, estimated glomerular filtration rate (eGFR), and urine calcium:creatinine (Ca:Cr) ratio.

RESULTS:

Progressive increases in serum 1,25-dihydroxyvitamin D and reductions in plasma iPTH and serum bone turnover markers were observed as mean posttreatment serum 25-hydroxyvitamin D rose from 13.9 ng/mL (in Quintile 1) to 92.5 ng/mL (in Quintile 5), irrespective of CKD stage. Mean serum calcium, phosphorus and FGF23, eGFR, and urine Ca:Cr ratio (collectively "safety parameters") did not significantly change from Quintile 1. Suppression of iPTH and bone turnover markers was not observed until serum 25-hydroxyvitamin D rose to at least 50.8 ng/mL (Quintile 3).

CONCLUSION:

ERC therapy produced exposure-dependent reductions in plasma iPTH and bone turnover markers only when mean serum total 25-hydroxyvitamin D reached at least 50.8 ng/mL, indicating that current targets for vitamin D repletion therapy in CKD are too low. Gradual elevation of mean serum 25-hydroxyvitamin D to 92.5 ng/mL was not associated with significant adverse changes in safety parameters.