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Vitamin D compounds in chronic kidney disease: change may be needed for good!
1 Department of Medicine, University of Otago, Christchurch, New Zealand 2 Mario Negri Sud, Italy
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Sir,
Over the last half a century, we have come to appreciate the importance of vitamin D prescription for people with renal disease. Vitamin D and its analogues have profoundly altered the natural history of deforming ‘renal rickets’. Observational studies have found significant associations between use of vitamin D compounds and improved survival [1,2]. We have now become convinced by clinical and experimental evidence that the abnormalities of calcium, phosphorus and parathyroid hormone observed in chronic kidney disease are associated with increased mortality [3–5]. Some of these abnormalities may be affected by treatment with vitamin D compounds. Our guidelines [6] have therefore reflected the need to target improvement of biochemical targets, including parathyroid hormone, phosphorus and calcium, which implies use of both pharmacological (vitamin D and its analogues, calcimimetics and phosphate binders) and non-pharmacological strategies (long-hours dialysis and dietary restriction). The management of bone