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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]
Vitamin D toxicity, or hypervitaminosis D, is the toxic state of an excess of vitamin D. The normal range for blood concentration of 25-hydroxyvitamin D in adults is 20 to 50 nanograms per milliliter (ng/mL).
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]
[4]: 100–101, 371–379 [5] [33] The prevalence of vitamin D deficiency increases with age due to a decrease in 7-dehydrocholesterol synthesis in the skin and a decline in kidney capacity to convert calcidiol to calcitriol, [34] the latter seen to a greater degree in people with chronic kidney disease. [35]
Vitamin D (the inactive version) is mainly from two forms: vitamin D 3 and vitamin D 2. Vitamin D 3, or cholecalciferol, is formed in the skin after exposure to sunlight or ultra violet radiation or from D 3 supplements or fortified food sources. Vitamin D 2, or ergocalciferol, is obtained from D 2 supplements or fortified food sources. [3]
effective in hypercalcemia due to malignancy with elevated vitamin D levels (many types of malignancies raise the vitamin D level). [22] also effective in hypervitaminosis D and sarcoidosis; dialysis usually used in severe hypercalcaemia complicated by kidney failure. Supplemental phosphate should be monitored and added if necessary