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International Journal of Nephrology
Volume 2011, Article ID 419524, 13 pages
http://dx.doi.org/10.4061/2011/419524
Review Article

Vitamin D Receptor Activators and Clinical Outcomes in Chronic Kidney Disease

1Specialty School of Nephrology, DMCO, University of Milano Via di Rudini 8, 20142 Milano, Italy
2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Via Pio II 3, 20153 Milano, Italy

Received 13 March 2011; Accepted 14 March 2011

Academic Editor: Biagio Raffaele Di Iorio

Copyright © 2011 Luciana Gravellone 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 deficiency appears to be an underestimated risk factor for cardiovascular disease in patients with chronic kidney disease. Evidence from both basic science and clinical studies supports the possible protective role of vitamin D beyond its effect on mineral metabolism. Toxicity of pharmacologic doses of active vitamin D metabolites, in particular calcitriol, is mainly due to the possibility of positive calcium and phosphorus balance. Therefore, vitamin D analogs have been developed, which suppress PTH secretion and synthesis with reduced calcemic and phosphatemic effects. Observational studies suggest that in hemodialysis patients the use of a vitamin D receptor (VDR) activator, such as calcitriol, doxercalciferol, paricalcitol, or alfacalcidol, is associated with a reduced mortality when compared with nonusers of any VDR activator. In this article the existing literature on the topic is reviewed, although a more robust answer to the question of whether or not VDR activators have beneficial effects in hemodialysis patients will hopefully come from a randomized controlled trial.