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Calcifediol binds in the blood to vitamin D-binding protein (also known as gc-globulin) and is the main circulating vitamin D metabolite. [4] [5] Calcifediol has an elimination half-life of around 15 to 30 days. [4] [9] Calcifediol is further hydroxylated at the 1-alpha-position in the kidneys to form 1,25-(OH) 2 D 3, calcitriol.
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 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]
Kidney disease results from kidney damage and subsequent decline in kidney function, says Dr. Pooja Budhiraja, a nephrologist and hypertension specialist at Mayo Clinic.
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]
This increases bone resorption. In chronic kidney failure the problem is more specifically failure to convert vitamin D to its active form in the kidney. The bone disease in secondary hyperparathyroidism caused by kidney failure is termed renal osteodystrophy. [49]
Vitamin D is a fat-soluble vitamin that helps our body absorb calcium, thereby supporting bone health, says Keri Gans, M.S., R.D., registered dietitian and author of The Small Change Diet.
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]
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