A large proportion of patients with chronic kidney disease (CKD) are vitamin D deficient (plasma 25-hydroxyvitamin D (25(OH)D) < 25 or 30 nmol/L per UK and US population guidelines) and this contributes to the development of CKD–mineral bone disease (CKD–MBD). Gaps in the evidence-base for the management of vitamin D status in relation to CKD–MBD are hindering the formulation of comprehensive guidelines. We conducted a systemic review of 22 RCTs with different forms of vitamin D or analogues with CKD–MBD related outcomes and meta-analyses for parathyroid hormone (PTH). We provide a comprehensive overview of current guidelines for the management of vitamin D status for pre-dialysis CKD patients. Vitamin D supplementation had an inconsistent effect on PTH concentrations and meta-analysis showed non- significant reduction (P = 0.08) whereas calcifediol, calcitriol and paricalcitol consistently reduced PTH. An increase in Fibroblast Growth Factor 23 (FGF23) with analogue administration was found in all 3 studies reporting FGF23, but was unaltered in 4 studies with vitamin D or calcifediol. Few RCTS reported markers of bone metabolism and variations in the range of markers prevented direct comparisons. Guidelines for CKD stages G1–G3a follow general population recommendations. For the correction of deficiency general or CKD-specific patient guidelines provide recommendations. Calcitriol or analogues administration is restricted to stages G3b–G5 and depends on patient characteristics. In conclusion, the effect of vitamin D supplementation in CKD patients was inconsistent between studies. Calcifediol and analogues consistently suppressed PTH, but the increase in FGF23 with calcitriol analogues warrants caution.

大部分慢性肾病 (CKD) 患者缺乏维生素 D（根据英国和美国人口指南，血浆 25-羟基维生素 D (25(OH)D) < 25 或 30 nmol/L），这有助于发展CKD-矿物质骨病（CKD-MBD）。与 CKD-MBD 相关的维生素 D 状态管理的证据基础上的差距阻碍了综合指南的制定。我们对 22 项使用不同形式的维生素 D 或类似物的 CKD-MBD 相关结果的随机对照试验进行了系统评价，并对甲状旁腺激素 (PTH) 进行了荟萃分析。我们全面概述了透析前 CKD 患者维生素 D 状态管理的现行指南。补充维生素 D 对 PTH 浓度的影响不一致，荟萃分析显示没有显着降低（ P = 0.08），而骨化二醇、骨化三醇和帕立骨化醇则持续降低 PTH。在所有 3 项报道 FGF23 的研究中发现，给予类似物后，成纤维细胞生长因子 23 (FGF23) 有所增加，但在 4 项使用维生素 D 或骨化二醇的研究中，该情况没有改变。很少有 RCTS 报告骨代谢标志物，而且标志物范围的变化阻碍了直接比较。 CKD G1-G3a 阶段的指南遵循一般人群的建议。对于纠正缺陷，一般或特定 CKD 患者指南提供了建议。骨化三醇或类似物的给药仅限于 G3b-G5 阶段，并取决于患者特征。总之，不同研究之间补充维生素 D 对 CKD 患者的效果不一致。骨化二醇和类似物始终抑制 PTH，但骨化三醇类似物会增加 FGF23，值得谨慎对待。