Is calcitriol treatment associated with improved survival in predialysis patients with chronic kidney disease?

Abstract

Observational studies have demonstrated that therapy with vitamin D analogs for treatment of secondary hyperparathyroidism is associated with improved survival in patients receiving maintenance hemodialysis. This Practice Point commentary discusses an observational study of male predialysis patients with stage 3–5 chronic kidney disease performed by Kovesdy et al., in which incidence rate ratios for all-cause mortality and combined death or dialysis initiation were found to be significantly lower in patients treated with calcitriol than in non-calcitriol-treated patients. These data are compatible with many experimental data on the beneficial effect of vitamin D analogs on the cardiovascular system, renal structure and renal function. Without data from randomized trials, however, it is still unclear whether calcitriol should be administered to all patients with chronic kidney disease, even those without secondary hyperparathyroidism.