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The kidneys are responsible for converting 25-hydroxyvitamin D to 1,25-hydroxyvitamin D. This is the active form of vitamin D in the body. Kidney disease reduces 1,25-hydroxyvitamin D formation, leading to a deficiency of the effects of vitamin D. [1]
Vitamin and mineral management for dialysis patients is a required treatment for people undergoing dialysis because during end-stage kidney disease and dialysis the kidneys are functioning at less than 15% of normal levels. [1] As a consequence, certain vitamin and mineral restrictions and supplementations are needed. [2]
The conversion of 25(OH) vitamin D to 1,25(OH)2 vitamin D is impaired, reducing intestinal calcium absorption and increasing PTH. [2] The kidney fails to respond adequately to PTH, which normally promotes phosphaturia and calcium reabsorption, or to FGF-23, which also enhances phosphate excretion. [2]
[4]: 100–101, 371–379 [5] [34] The prevalence of vitamin D deficiency increases with age due to a decrease in 7-dehydrocholesterol synthesis in the skin and a decline in kidney capacity to convert calcidiol to calcitriol, [35] the latter seen to a greater degree in people with chronic kidney disease. [36]
Calcitriol is a hormone and the active form of vitamin D, normally made in the kidney. [8] [9] [10] It is also known as 1,25-dihydroxycholecalciferol.It binds to and activates the vitamin D receptor in the nucleus of the cell, which then increases the expression of many genes. [11]
What is vitamin D good for? Vitamin D is essential for the bones and teeth, the immune system, brain health, and for regulating inflammation. The body produces vitamin D as a response to sun exposure.
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