Vitamin D Status in Chronic Kidney Disease - UVB Irradiation Is Superior to Oral Supplementation

Background: In chronic kidney disease (CKD) a deficiency of 1,25-dihydroxyvitamin D is common. The aim of this review was to compare vitamin D status after oral supplementation of vitamin D₃ to that of serial suberythemal irradiation in end-stage kidney disease (ESKD) patients. Patients and Methods: Ninety-five patients, with a mean age of 62 (range=35-82) years, were treated with a mean dose of 35,000 (20,000–60,000) IU vitamin D₃ per week for a period of 18 months. Fourteen patients, with a mean age of 51 (range=41-57) years, were whole-body UVB irradiated for over 6 months. From 3 hemodialysis patients skin biopsies were performed. Results: With oral supplementation 25(OH)D₃ increased by 60%. With UV irradiation 25(OH)D₃ increased by 400%. Gene expression analysis demonstrated an improvement in the vitamin D receptor (VDR) by 0.65 fold, in 1-alpha-hydroxylase (CYP27B1) by 1.0 fold, and in 25-hydroxylase (CYP2R) by 1.2 fold. Conclusion: Serial suberythemal UVB irradiation of patients with CKD on dialysis is capable to improve serum 25(OH)D₃ and 1,25(OH)₂D₃ by enhancing the skin's ability to activate vitamin D.

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