PTH and chronic kidney disease: Finally, observational studies have demonstrated that non-dialysis dependent CKD and HD patients treated with active vitamin D have a lower risk for death.[67, 68] All these studies raise the question if there is a need to change the clinical paradigm, i.e., rather than using vitamin D therapy to manage secondary hyperparathyroidism, should vitamin D repletion be the goal of therapy irrespective of serum parathyroid hormone levels at all stages of CKD, including dialysis patients?