Abstract：
Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.
摘要：
慢性肾脏病（CKD）是全球范围内非常普遍的疾病，其中肾脏丧失许多功能，如维生素D（VD）代谢的调节。此外，CKD患者多因子VD缺乏的风险较高，这与糟糕的结果广泛相关，包括骨病,心血管疾病,和更高的死亡率。就负面结果与低水平VD的关联而言，证据丰富，但最近的研究降低了以前对普通人群中补充VD的有益效果的高期望.虽然争议依然存在,VD的诊断和治疗并未被排除在肾脏病学指南之外，许多数据仍然支持CKD患者补充VD。在这篇叙述性评论中，我们简要总结了不断发展的争议和有用的临床方法，强调必须平衡VD衍生物的不良反应与有效预防进行性和严重继发性甲状旁腺功能亢进的需要。指导方针各不相同，但似乎普遍同意CKD患者应避免VD缺乏，并且很可能不应该等到出现严重的SHPT才谨慎地开始VD衍生物。此外，需要强调的是,目标不应该是甲状旁腺激素(PTH)水平的完全正常化.新的发展可能有助于我们更好地定义不同CKD阶段的最佳VD和PTH，但仍需要大量试验来证实VD和这些和其他CKD-MBD生物标志物的精确控制与改善该人群的硬性结局明确相关.
