Vitamin D in health and disease

Robert P. Heaney

Research output: Contribution to journalArticle

217 Citations (Scopus)

Abstract

Vitamin D functions in the body through both an endocrine mechanism (regulation of calcium absorption) and an autocrine mechanism (facilitation of gene expression). The former acts through circulating calcitriol, whereas the latter, which accounts for more than 80% of the metabolic utilization of the vitamin each day, produces, uses, and degrades calcitriol exclusively intracellularly. In patients with end-stage kidney disease, the endocrine mechanism is effectively disabled; however, the autocrine mechanism is able to function normally so long as the patient has adequate serum levels of 25(OH)D, on which its function is absolutely dependent. For this reason, calcitriol and its analogs do not constitute adequate replacement in managing vitamin D needs of such patients. Optimal serum 25(OH)D levels are greater than 32 ng/mL (80 nmol/L). The consequences of low 25(OH)D status include increased risk of various chronic diseases, ranging from hypertension to diabetes to cancer. The safest and most economical way to ensure adequate vitamin D status is to use oral dosing of native vitamin D. (Both daily and intermittent regimens work well.) Serum 23(OH)D can be expected to rise by about 1 ng/mL (2.5 nmol/L) for every 100 IU of additional vitamin D each day. Recent data indicate that cholecalciferol (vitamin D3) is substantially more potent than ergocalciferol (vitamin D2) and that the safe upper intake level for vitamin D3 is 10,000 IU/d.

Original languageEnglish
Pages (from-to)1535-1541
Number of pages7
JournalClinical journal of the American Society of Nephrology : CJASN
Volume3
Issue number5
DOIs
StatePublished - Sep 2008

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Vitamin D
Calcitriol
Cholecalciferol
Health
Ergocalciferols
Serum
Vitamins
Chronic Kidney Failure
Chronic Disease
Hypertension
Calcium
Gene Expression
Neoplasms

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Vitamin D in health and disease. / Heaney, Robert P.

In: Clinical journal of the American Society of Nephrology : CJASN, Vol. 3, No. 5, 09.2008, p. 1535-1541.

Research output: Contribution to journalArticle

Heaney, Robert P. / Vitamin D in health and disease. In: Clinical journal of the American Society of Nephrology : CJASN. 2008 ; Vol. 3, No. 5. pp. 1535-1541.
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