Active vitamin D represents a relevant treatment for CKD-MBD. Recent data suggest new applications of active vitamin D beyond secondary hyperparathyroidism, such as the control of albuminuria and left ventricular hypertrophy in diabetic patients with CKD stage 3–4. Native vitamin D has contemporarily received a growing interest due to several pleiotropic effects, potentially induced at autocrine-paracrine level, even in the late stages of CKD. However, the efficacy of vitamin D in terms of clinically relevant outcome is still based on observational data. The present review summarizes the evidences and the unanswered questions concerning the use of vitamin D in CKD-MBD, with special attention to the rationale for native vitamin D administration in dialysis patients.
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