Does treatment with calcitriol improve survival in predialysis patients with chronic kidney disease?

Treatment of secondary hyperparathyroidism with activated vitamin D analogs has been associated with improved survival of dialysis-dependent patients with chronic kidney disease (CKD). Whether this treatment regimen affords similar benefits to non-dialysis-dependent patients with CKD remains unclear. In this Practice Point commentary, we discuss a study by Kovesdy et al. that reported enhanced survival in predialysis patients with CKD who received calcitriol for a median duration of 2.1 years. Despite the achievement of favorable results in these patients, the study had several limitations that could preclude generalization of the findings to other populations. These limitations included the nonrandomized, observational design, the small patient population, the exclusive enrollment of men (76.5% of whom were white), and the lack of information on cause of death. Here, we place the findings of the study into clinical context and emphasize the urgent need for large, well-designed, randomized trials that aim to assess cardiovascular and mortality end points.