Benefits from vitamin D supplementation in kidney disease vary; routine testing is not recommended in otherwise healthy patients with chronic kidney disease.
When it comes to issues of vitamin D in chronic kidney disease (CKD), core certainties include that most patients with CKD have dysregulated 25-hydroxy vitamin D (25[OH]D) and nutritional supplementation can increase those levels. Beyond that, complexities abound, with evidence fraught with confounders regarding who may or may not benefit from supplementation. While evidence is weak regarding meaningful benefits such as mortality, in other scenarios, such as prevention of type 2 diabetes in adults with prediabetes, there is solid evidence of benefit. Ultimately, "just because you can measure vitamin D and raise the level doesn't mean your patients will feel any better," Anastassios G. Pittas, MD, chief of the Division of Endocrinology at Tufts Medical Center, Boston, noted, speaking at the National Kidney Foundation 2025 Spring Clinical Meetings. "Routine testing is not needed for patients with CKD who are otherwise healthy," he told Medscape Medical News. "A thoughtful, individualized approach is better than a one-size-fits-all practice, especially since 25(OH)D thresholds vary by populations." Key research detailing the benefits, or lack thereof, includes a meta-analysis of 128 studies involving 11,270 patients comparing vitamin D with a wide range of variables including placebo, other vitamin D formulations, different doses or routes of administration, calcium, or cinacalcet, in people with advanced CKD (stage III, IV, or V), explained co-presenter Daniel Weiner, MD, medical director of clinical research for Dialysis Clinic, Inc. Overall, the analysis showed that compared with placebo, vitamin D therapy likely had no effect on the outcomes examined including all-cause death (relative risk [RR], 1.04), "uncertain" effects on fracture (RR, 0.68), and cardiovascular death (RR, 0.73) in this population with advanced CKD. "We can see from these findings that, whether it is nutritional vitamin D or activated [vitamin D], in the CKD population, there simply is…