Vitamin D and Stage 5 Chronic Kidney Disease: A New Paradigm
Seminars in Dialysis, 10/14/2011
Heaf JG et al. – Vitamin D receptor agonists (VDRA) are currently recommended for the treatment of secondary hyperparathyroidism in stage 5 CKD. They are considered to be contraindicated in the presence of low or normal (for a dialysis patient) levels of PTH due to the risk of developing adynamic bone disease, with consequent vascular calcification. However, these recommendations are increasingly at odds with the epidemiological evidence, which consistently shows a large survival advantage for patients treated with low–dose VDRAs, regardless of plasma calcium, phosphate, or PTH.