The metabolism of vitamin D (VD) is severely impaired in chronic kidney disease (CKD). Uremia is not only associated with the reduction of its active form 1,25-dihydroxyvitamin D but also in the reduction of all VD metabolites. CKD-associated abnormalities in VD are part of the CKD-related mineral-bone disease. However, VD has beneficial effect on the kidneys due to its pleiotropic effects, namely, antiproteinuric effect and renin-angiotensin-aldosterone system suppression, thus making the relationship between VD and the kidney even more complicated. The aim of our chapter is to reveal the changes in vitamin D axis in CKD, to outline the possible beneficial effects of vitamin D in renal patients, including end-stage renal patients and kidney transplant recipients, and to address the current opinions concerning treatment with cholecalciferol, calcitriol, and vitamin D analogs.
Part of the book: A Critical Evaluation of Vitamin D
Plasma exchange (PEX) is a treatment method with increasing range of indications. However, due to the small number of randomized trials, its effectiveness is still under debate in certain conditions. The aim of our chapter is to present the major principles of PEX, discuss safety issues and reveal current data for treatment effectiveness of the method. Novel indications for PEX will also be discussed.
Part of the book: Plasma Medicine
Vitamin D deficiency is highly prevalent in patients with renal disease. The abnormal vitamin D (VD) metabolism in chronic kidney disease (CKD) is a key factor for developing CKD-related mineral bone disease (CKD-MBD), which directly influences the survival of the CKD patients. The importance of VD is perhaps of greater value due to its pleiotropic effects that span beyond calcium-phosphorus metabolism (cancer protection, diabetes prevention, and renal protection). The aim of our chapter is to depict the clinical implications of VD deficiency in the setting of CKD, including VD pleiotropy in renal disease, and to propose the most adequate treatment suggested in the literature.
Part of the book: Vitamin D Deficiency
Kidney transplantation (KT) is the best renal replacement therapy in patients with chronic kidney disease (CKD). However, its success is limited due to insufficient number of donors worldwide and graft or patient loss. A major cause for poorer graft survival is donor-specific antibodies (DSAs). Therapeutic apheresis (TA) is a well-recognized option for increasing the donor pool by treating HLA-sensitized patients and making AB0-incompatible KT possible. In addition, its use in patients with DSA has beneficial effect on graft survival. The aim of our review is to demonstrate the current knowledge on the use of TA (plasma exchange and immunoadsorption) in KT. In addition to the current guidelines, new trends in TA use prior to and after KT will be reviewed.