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BioMed Research International
Volume 2013 (2013), Article ID 864012, 10 pages
http://dx.doi.org/10.1155/2013/864012
Review Article

Which Vitamin D in CKD-MBD? The Time of Burning Questions

1Medical Department, Nephrology Unit, AO Desio Vimercate, Desio Hospital, 20832 Desio, Italy
2Department of Nephrology, Sant’Anna Hospital, 22020 Como, Italy
3Department of Health Sciences, University of Milan, 20142 Milan, Italy
4Division of Nephrology, Dialysis Center CBH-Città di Bisceglie, 70052 Bisceglie, Italy

Received 29 April 2013; Revised 4 July 2013; Accepted 8 July 2013

Academic Editor: Youhua Liu

Copyright © 2013 Andrea Galassi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Vitamin D is a common treatment against secondary hyperparathyroidism in renal patients. However, the rationale for the prescription of vitamin D sterols in chronic kidney disease (CKD) is rapidly increasing due to the coexistence of growing expectancies close to unsatisfactory evidences, such as (1) the lack of randomized controlled trials (RCTs) proving the superiority of any vitamin D sterol against placebo on patients centered outcomes, (2) the scanty clinical data on head to head comparisons between the multiple vitamin D sterols currently available, (3) the absence of RCTs confirming the crescent expectations on nutritional vitamin D pleiotropic effects even in CKD patients, (4) the promising effects of vitamin D receptors activators (VDRA) against proteinuria and myocardial hypertrophy in diabetic CKD cohorts, and (5) the conflicting data on the impact on mortality of VDRA versus calcimimetic centered regimens to control CKD-MBD. The present review arguments these issues focusing on the opened questions that nephrologists should consider dealing with the prescription of nutritional vitamin D or VDRA and with the choice of a VDRA versus a calcimimetic based regimen in CKD-MBD patients.