Vitamin D and Peritoneal Dialysis

Chronic kidney disease – mineral and bone disorder (CKD–MBD) is a cause of significant morbidity and mortality in patients with long-standing kidney disease. Management of secondary hyperparathyroidism includes the use of phosphorus-binding agents and treatment with activated vitamin D compounds, better referred to as vitamin D receptor agonists (VDRAs). In an effort to maximize the therapeutic response while reducing the adverse effects of calcitriol, the naturally synthesized hormone, the use of intravenous administration and several selective VDRAs have been developed. Recently, oral preparations of these selective VDRAs have become available, enabling their use in the peritoneal dialysis (PD) population. The present report reviews the data concerning the use of oral VDRAs for the treatment of hyperparathyroidism in PD patients. The data, although limited, appear to support the use of oral paricalcitol as the VDRA in PD patients. In addition, traditional teaching focuses only on therapy with VDRAs, ignoring vitamin D replacement in CKD stage 5. However, given the potential benefits of calcidiol (25-OH-D) repletion and the rampant 25-OH-D deficiency in the PD population, our opinion is that screening for and treating that deficiency should extend beyond early CKD and also include PD patients.