Vitamin D analogues to target residual proteinuria: potential impact on cardiorenal outcomes

Jelmer K. Humalda, David J. A. Goldsmith, Ravi Thadhani, Martin H. de Borst*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Scopus)

Abstract

Residual proteinuria, the amount of proteinuria that remains during optimally dosed renin-angiotensin-aldosterone system (RAAS) blockade, is an independent risk factor for progressive renal function loss and cardiovascular complications in chronic kidney disease (CKD) patients. Dual RAAS blockade may reduce residual proteinuria but without translating into improved cardiorenal outcomes at least in diabetic nephropathy; rather, dual RAAS blockade may increase the risk of adverse events. These findings have challenged the concept of residual proteinuria as an absolute treatment target. Therefore, new strategies must be explored to address whether by further reduction of residual proteinuria using interventions not primarily targeting the RAAS benefit in terms of cardiorenal risk reduction would accrue. Both clinical and experimental intervention studies have demonstrated that vitamin D can reduce residual proteinuria through both RAAS-dependent and RAAS-independent pathways. Future research should prospectively explore vitamin D treatment as an adjunct to RAAS blockade in an interventional trial exploring clinically relevant cardiorenal end points.

Original languageEnglish
Pages (from-to)1988-1994
Number of pages7
JournalNephrology, Dialysis, Transplantation
Volume30
Issue number12
Early online date20-Jan-2015
DOIs
Publication statusPublished - Dec-2015

Keywords

  • cardiovascular disease
  • chronic kidney disease
  • proteinuria
  • vitamin D
  • CHRONIC KIDNEY-DISEASE
  • RENIN-ANGIOTENSIN SYSTEM
  • RANDOMIZED CONTROLLED-TRIAL
  • DIETARY-SODIUM RESTRICTION
  • CHRONIC RENAL-DISEASE
  • D-BINDING PROTEIN
  • CARDIOVASCULAR EVENTS
  • DIABETIC-NEPHROPATHY
  • URINARY SODIUM
  • 1,25-DIHYDROXYVITAMIN D-3

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