Biweekly Vitamin D Supplementation Improves Biomarkers but Not Proven to Slow CKD Progression: Study
A recent study published in the Indian Journal of Nephrology in June 2026 reveals that while biweekly cholecalciferol effectively restores vitamin D levels (+31.89 ng/mL) and improves inflammatory and bone turnover markers, its clinical power to halt chronic kidney disease (CKD) progression or prevent major cardiovascular events remains unproven.
Although vitamin D deficiency in chronic kidney disease (CKD) is strongly linked to cardiovascular mortality, the long-term clinical benefits of high-dose supplementation remain unproven. To address this critical gap, Dr. Vivek Kumar and researchers at PGIMER, Chandigarh, evaluated the precise impact of cholecalciferol on cardiovascular disease (CVD), systemic inflammation, and bone metabolism markers in patients with pre-dialysis CKD.
In a randomized, double-blind feasibility trial, 89 pre-dialysis CKD patients (eGFR 10-45 mL/min/1.73 m²; baseline vitamin D 20-50 ng/mL) received biweekly cholecalciferol (60,000 IU) or placebo for 36 months. Excluding those with hypercalcemia or recent vitamin D use, researchers primarily evaluated major adverse cardiovascular events (MACE), alongside secondary endpoints of all-cause mortality and key biomarker shifts.
Key Clinical Findings of the Study Includes:
Vitamin D Elevation: The study reported a profound surge in serum 25-hydroxyvitamin D concentrations among the treated cohort, achieving a mean between-group difference of 31.89 ng/mL (p <0.001).
Inflammatory Modulation: The study noted a statistically significant decline in circulating C-reactive protein (CRP) levels, yielding a mean reduction of -1.97 ng/mL when compared directly to the placebo group.
Bone Remodeling: The study demonstrated targeted bone metabolism improvements, evidenced by a marked between-group reduction in bone-specific alkaline phosphatase (BAP) by -5.08 U/L (p = 0.019).
FGF-23 Fluctuations: The study observed that intact fibroblast growth factor-23 (FGF-23) unexpectedly increased in both the active treatment and matching placebo arms across the 12-month follow-up interval.
Cardiovascular Outcomes: The study concluded that despite positive biochemical shifts, the rates of MACE, the ultimate need for renal replacement therapy, and overall all-cause mortality remained statistically similar between cohorts.
The results suggest that deploying biweekly doses of 60,000 IU of cholecalciferol is highly effective at restoring depleted vitamin D reserves while dampening intermediate markers of systemic inflammation and active bone turnover, though this targeted intervention unfortunately does not translate directly into a measurable reduction of MACE or end-stage renal disease progression.
Thus, the study concludes clinicians may thoughtfully consider prescribing appropriate vitamin D supplementation to address specific biochemical deficiencies and manage complex bone metabolism profiles in their pre-dialysis patients, while gently monitoring longitudinal serum levels to actively avoid inadvertently elevating counterproductive risk markers like FGF-23, rather than utilizing it strictly as a standalone primary cardioprotective therapy.
Although limited by a shorter feasibility follow-up duration, a relatively constrained participant cohort size, and the exclusive utilization of a single vitamin D formulation, future well-powered multicenter trials with extended observation periods would be valuable to firmly establish the ultimate practical utility of sustained supplementation on hard clinical endpoints.
Reference
Kamboj K, Manoharan K, Sharma S, Khera H, Shafiq N, Kohli HS, Yadav AK, Kumar V, Jha V. Effect of Cholecalciferol Supplementation on CVD, Inflammation, and Bone Metabolism Markers in CKD: A Randomized Double Blind Placebo Controlled Feasibility Trial. Indian Journal of Nephrology. 2026 June.
