Vitamin D receptors are expressed not only in the classical target organs (bone, parathyroid glands, kidneys and intestine) but also in other non-classical targets including arteries, heart, immune system, endocrine organs, and nervous system. Therefore, the deficiency of active forms of vitamin D in uremia may explain various abnormalities in biological functions and survival disadvantage in this disease condition. Previous studies reported that treatment with vitamin D had beneficial effects on cardiac and immune functions in dialysis patients. A recent observational cohort study indicated that the mortality risk was different between the groups taking different types of vitamin D analogues. We found that patients on a low-dose oral alfacalcidol showed a significantly lower risk for cardiovascular death than those without vitamin D supplementation. Although these observations need further confirmation by randomized controlled studies, appropriate use of active forms of vitamin D may improve the outcomes of patients with chronic kidney disease.