The diminished absorption of calcium and the osteodystrophy which accompany chronic renal disease are often "resistant" to vitamin D. The basis for this resistance remains uncertain. Recent studies have emphasized the role of an abnormality in vitamin D metabolism in accounting for the alterations in calcium absorption and the apparent vitamin D resistance which occur in renal failure. The results of experiments in this laboratory with a uremic animal model strongly suggest that in addition to the proposed mechanism involving an interference with the metabolism of vitamin D, renal insufficiency also affects the cellular reactions mediating calcium transport in a manner which, while opposite in direction to that of vitamin D, is independent of a direct interaction with the vitamin or its metabolites.
Kimberg DV, Baerg RD, Gershon E. The Nature of Vitamin D Resistance in Experimental Uremia. Arch Intern Med. 1970;126(5):891-895. doi:10.1001/archinte.1970.00310110161029