Vitamin D receptor activation and survival in chronic kidney disease

Kidney Int. 2008 Jun;73(12):1355-63. doi: 10.1038/ki.2008.35. Epub 2008 Feb 20.


Replacement of activated vitamin D has been the cornerstone of therapy for secondary hyperparathyroidism (SHPT). Recent findings from several large observational studies have suggested that the benefits of vitamin D receptor activators (VDRA) may extend beyond the traditional parathyroid hormone (PTH)-lowering effect, and could result in direct cardiovascular and metabolic benefits. The advent of several new analogs of the activated vitamin D molecule has widened our therapeutic armamentarium, but has also made therapeutic decisions more complicated. Treatment of SHPT has become even more complex with the arrival of the first calcium-sensing receptor (CSR) agonist (cinacalcet hydrochloride) and with the uncovering of novel mechanisms responsible for SHPT. We provide a brief overview of the physiology and pathophysiology of SHPT, with a focus on vitamin D metabolism, and discuss various practical aspects of VDRA therapy and its reported association with survival in recent observational studies. A detailed discussion of the available agents is aimed at providing the practicing physician with a clear understanding of the advantages or disadvantages of the individual medications. A number of open questions are also analyzed, including the present and future roles of CSR agonists and 25(OH) vitamin D replacement.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Humans
  • Hyperparathyroidism, Secondary / drug therapy*
  • Hyperparathyroidism, Secondary / etiology
  • Hyperparathyroidism, Secondary / metabolism
  • Kidney Diseases / complications
  • Kidney Diseases / mortality*
  • Parathyroid Hormone / blood
  • Parathyroid Hormone / metabolism
  • Receptors, Calcitriol / agonists*
  • Vitamin D / analogs & derivatives*
  • Vitamin D / pharmacology
  • Vitamin D / therapeutic use*


  • Parathyroid Hormone
  • Receptors, Calcitriol
  • Vitamin D