OBJECTIVES: The objective of this study is to evaluate hospitalizations, outpatient services and medication use in the first year of dialysis associated with pre-dialysis treatment with paricalcitol compared to no predialysis vitamin D receptor (VDR) activator use in chronic kidney disease (CKD) patients with SHPT. METHODS: A matched cohort analysis was conducted in 154 hemodialysis patients comparing utilization outcomes of predialysis use of paricalcitol compared to no VDR activator treatment, using the Medstat™ administrative claims database from 2000-2007. Patients were matched using propensity scoring for age, gender, Charlson co-morbidity Index, and pre-index total costs. Multivariate models adjusted for age, gender, insurance, physician type, region, pre-dialysis co-morbidities, and pre-dialysis costs were used to evaluate the impact of pre-dialysis paricalcitol treatment on hospitalizations, outpatient services, and medication use in first year of dialysis. RESULTS: Multivariable analysis demonstrated predialysis paricalcitol use was associated with statistically significant reductions in all-cause hospitalizations (0.806, 95%CI: 0.684 – 0.950), all-cause outpatient services (0.953, 95%CI: 0.933 – 0.973) and CKD-related hospitalizations (0.780, 95% CI: 0.635 – 0.958); CKD-related outpatient visits (0.962, 95% CI: 0.938 – 0.987); and CKD-related medications (0.922, 95% CI: 0.852 – 0.996) in the first year of dialysis compared with no predialysis VDR activator treatment. CONCLUSIONS: Paricalcitol treatment for SHPT prior to dialysis is associated with fewer CKD-related medications; and all-cause and CKD-related outpatient services and hospitalizations in the first year of dialysis compared to no VDR activator treatment. Payers should consider these findings when make coverage decisions regarding the use of paricalcitol. Further studies are needed to confirm these results.