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Hari Kumar K. V. S., MD; Kirtikumar D. Modi, MD, DM; Ratan Jha, MD, DM

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The study by Kovesdy et al¹ showed that treatment with activated vitamin D (calcitriol) therapy significantly increased survival in patients with CKD not receiving dialysis. However, baseline data between treated and untreated groups was not comparable regarding the bone and mineral abnormalities. The baseline parathyroid hormone (PTH) level was high in the calcitriol group (152 pg/mL vs 75 pg/mL), and more patients in the calcitriol group were using calcium and phosphate binder, indicating that more patients in the calcitriol group had secondary hyperparathyroidism. Thus, a simple explanation of observed benefit with calcitriol therapy is by correcting secondary hyperparathyroidism.

Secondary hyperparathyroidism contributes significantly to progression of the kidney disease and increase in mortality.² Previous studies suggest a decreased progression of CKD with better management of associated mineral and bone disorders.³ To suggest a benefit of activated . . . [Full Text of this Article]

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