PTH and Hypercalcemia: CKD-focused RCTs (Randomized Controlled Trials) indicate that in non-dialysis CKD, selective or non-selective VDRAs lower PTH but fail to improve LV mass/function or clinical hard outcomes and increase hypercalcemia risk (89, 90); in hemodialysis, oral alfacalcidol did not reduce cardiovascular composites or mortality (91), whereas nutritional vitamin D (cholecalciferol/calcifediol) raises 25(OH)D and improves biochemistry with neutral/insufficient evidence for hard outcomes so far (92–94).