The role of nutritional vitamin D in chronic kidney disease–mineral and bone disorder in children and adults with chronic kidney disease, on dialysis, and after kidney transplantation—a European consensus statement

TY - JOUR

T1 - The role of nutritional vitamin D in chronic kidney disease–mineral and bone disorder in children and adults with chronic kidney disease, on dialysis, and after kidney transplantation—a European consensus statement

AU - Jørgensen, Hanne Skou

AU - Vervloet, Marc

AU - Cavalier, Etienne

AU - Bacchetta, Justine

AU - de Borst, Martin H.

AU - Bover, Jordi

AU - Cozzolino, Mario

AU - Ferreira, Ana Carina

AU - Hansen, Ditte

AU - Herrmann, Markus

AU - de Jongh, Renate

AU - Mazzaferro, Sandro

AU - Wan, Mandy

AU - Shroff, Rukshana

AU - Evenepoel, Pieter

N1 - Publisher Copyright: © The Author(s) 2025. Published by Oxford University Press on behalf of the ERA.

PY - 2025/4

Y1 - 2025/4

N2 - Vitamin D deficiency is common in patients with chronic kidney disease (CKD) and associates with poor outcomes. Current clinical practice guidelines recommend supplementation with nutritional vitamin D as for the general population. However, recent large-scale clinical trials in the general population failed to demonstrate a benefit of vitamin D supplementation on skeletal or non-skeletal outcomes, fueling a debate on the rationale for screening for and correcting vitamin D deficiency, both in non-CKD and CKD populations. In a collaboration between the European Renal Osteodystrophy initiative of the European Renal Association (ERA) and the European Society for Paediatric Nephrology (ESPN), an expert panel performed an extensive literature review and formulated clinical practice points on vitamin D supplementation in children and adults with CKD and after kidney transplantation. These were reviewed by a Delphi panel of members from relevant working groups of the ERA and ESPN. Key clinical practice points include recommendations to monitor for, and correct, vitamin D deficiency in children and adults with CKD and after kidney transplantation, targeting 25-hydroxyvitamin D levels >75 nmol/l (>30 ng/ml). Although vitamin D supplementation appears well-tolerated and safe, it is recommended to avoid mega-doses (≥100 000 IU) and very high levels of 25 hydroxyvitamin D (>150–200 nmol/l, or 60–80 ng/ml) to reduce the risk of toxicity. Future clinical trials should investigate the benefit of vitamin D supplementation on patient-relevant outcomes in the setting of vitamin D deficiency across different stages of CKD.

AB - Vitamin D deficiency is common in patients with chronic kidney disease (CKD) and associates with poor outcomes. Current clinical practice guidelines recommend supplementation with nutritional vitamin D as for the general population. However, recent large-scale clinical trials in the general population failed to demonstrate a benefit of vitamin D supplementation on skeletal or non-skeletal outcomes, fueling a debate on the rationale for screening for and correcting vitamin D deficiency, both in non-CKD and CKD populations. In a collaboration between the European Renal Osteodystrophy initiative of the European Renal Association (ERA) and the European Society for Paediatric Nephrology (ESPN), an expert panel performed an extensive literature review and formulated clinical practice points on vitamin D supplementation in children and adults with CKD and after kidney transplantation. These were reviewed by a Delphi panel of members from relevant working groups of the ERA and ESPN. Key clinical practice points include recommendations to monitor for, and correct, vitamin D deficiency in children and adults with CKD and after kidney transplantation, targeting 25-hydroxyvitamin D levels >75 nmol/l (>30 ng/ml). Although vitamin D supplementation appears well-tolerated and safe, it is recommended to avoid mega-doses (≥100 000 IU) and very high levels of 25 hydroxyvitamin D (>150–200 nmol/l, or 60–80 ng/ml) to reduce the risk of toxicity. Future clinical trials should investigate the benefit of vitamin D supplementation on patient-relevant outcomes in the setting of vitamin D deficiency across different stages of CKD.

KW - chronic kidney disease–mineral and bone disorder

KW - kidney transplantation

KW - parathyroid hormone

KW - renal osteodystrophy

KW - vitamin D

UR - http://www.scopus.com/inward/record.url?scp=105001962863&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfae293

DO - 10.1093/ndt/gfae293

M3 - Journal article

C2 - 39875204

AN - SCOPUS:105001962863

SN - 0931-0509

VL - 40

SP - 797

EP - 822

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 4

ER -