Vitamin D therapy in patients with chronic renal disease: The role of the renal dietitian

Chronic renal failure causes decreased vitamin D production, which profound ly alters parathyroid hormone (PTH) metabolism, and calcium and phosphorus balance. Correcting this deficiency is an important strategy in managing se condary hyperparathyroidism (SHPT) and helping to restore mineral balance. However, hypercalcemia and hyperphosphatemia are common side effects that h amper vitamin D hormone therapy by increasing dietary calcium and phosphoru s absorption. This limitation has led to the development of D-hormone analo gs that retain the ability to suppress PTH levels without causing drastic c hanges in calcium and phosphorus metabolism. These analogs have the potenti al to advance the management of SHPT. Renal dietitians can play a leading r ole in ensuring successful management of SHPT by participating in early pat ient intervention for abnormal mineral and vitamin D metabolism, by encoura ging long-term phosphorus control, and by updating and implementing clinica l protocols that promote optimal hormone levels (D and PTH), mineral levels (phosphorus and calcium), and nutritional factors. (C) 2000 by the Nationa l Kidney Foundation, Inc.