Most patients with advanced kidney disease take vitamin D compounds to prevent secondary hyperparathyroidism. Palmer and colleagues'
meta-analysis of 76 randomized trials found no good evidence that vitamin D compounds reduced risk for death, bone pain, vascular
calcification, or need for parathyroidectomy in patients with chronic kidney disease (CKD). Compared with placebo, older vitamin
D sterols increased the risk for hypercalcemia and hyperphosphatemia, whereas newer vitamin D analogues increased the risk
for hypercalcemia but not hyperphosphatemia. Direct comparisons between newer analogues and established agents found no advantage
to newer drugs. Vitamin D compounds do not reduce adverse outcomes in CKD and might increase them.