Vitamin D status and supplementation in left ventricular remodeling in chronic kidney disease: A systematic review and meta-analysis

Chronic kidney disease (CKD) is frequently accompanied by left ventricular remodeling, a major contributor to cardiovascular morbidity and mortality, while vitamin D deficiency is highly prevalent in this population. This systematic review and meta-analysis aimed to assess the association between vitamin D status and left ventricular remodeling and to evaluate whether vitamin D supplementation improves remodeling-related cardiac parameters in adults with CKD. Eight databases were searched through December 25, 2024, for observational and interventional studies reporting left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), or interventricular septal thickness (IVST). Sixteen studies were included: seven observational studies involving 1,487 participants and nine interventional studies involving 581 participants. In observational studies, higher vitamin D levels were associated with lower LVMI (r = -0.41, 95% confidence interval [CI]: -0.64 to -0.11), although heterogeneity was substantial and the certainty of evidence was very low. Vitamin D supplementation did not significantly improve LVMI (standardized mean difference [SMD] = -0.20, 95% CI: -0.62 to 0.22) or LVEF (SMD = 0.57, 95% CI: -0.32 to 1.46). A possible reduction in IVST was observed (SMD = -0.68, 95% CI: -1.32 to -0.05), but this finding was based on limited and inconsistent evidence. Overall, higher vitamin D status was associated with lower LVMI, whereas current interventional evidence does not establish that vitamin D supplementation improves left ventricular remodeling in CKD. Larger, adequately powered, long-term randomized trials are needed to determine whether specific CKD populations may derive cardiovascular structural benefit from vitamin D therapy.