The complex biological actions of vitamin D suggest its involvement in a host of physiologic processes and consequently in the development of various pathologic processes. Epidemiologic data suggest a significant and worsening prevalence of hypovitaminosis D in the general population, which is exacerbated in certain patient groups such as those with CKD. Observational data also suggest a robust association between hypovitaminosis D and all-cause and cardiovascular mortality, cardiovascular risk factors, and cardiovascular and peripheral vascular disease incidence and prevalence.

The association of vitamin D with cancer-related mortality and its role in the development of various types of cancers is less compelling, suggesting the need for more complex studies to explore the role of genetic polymorphisms of the vitamin D receptor among others. Properly powered randomized controlled trials examining the effects of vitamin D replacement therapy on all-cause and cardiovascular mortality will have to be performed to complete our understanding of the role that vitamin D plays.

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A meta-analysis of 18 randomized controlled trials of vitamin D supplementation showed that patients randomized to vita­min D supplementation experienced fewer deaths compared to those receiving placebo.66 As the individual trials included in this meta-analysis have not always shown a significant effect of vitamin D supplementation, the clinical utility of such an approach remains unclear and requires further examination.

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