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Oral active vitamin d treatment and mortality in maintenance hemodialysis patients
Shukun Wu1, Junru Wang1, Fang Wang1
1Department of Nephrology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, PR China.
Insights
Oral active vitamin D treatment showed a potential survival benefit for maintenance hemodialysis patients. However, further research is needed to confirm this association in larger studies.
Area of Science:
- Nephrology
- Endocrinology
- Clinical Medicine
Background:
- Maintenance hemodialysis (MHD) patients often experience complications related to mineral and bone disorders.
- Active vitamin D analogs are used to manage secondary hyperparathyroidism in these patients.
Purpose of the Study:
- To investigate the association between oral active vitamin D (calcitriol) therapy and mortality rates in patients undergoing maintenance hemodialysis.
- To analyze the impact of calcitriol on both all-cause and cardiovascular mortality.
Main Methods:
- A cohort of 156 maintenance hemodialysis patients was studied.
- Survival analysis, including Kaplan-Meier and Cox proportional-hazards models, was used to assess mortality risk.
- Patients were categorized based on whether they received oral calcitriol treatment.
Main Results:
- Oral active vitamin D treatment was associated with significantly lower crude risks of all-cause and cardiovascular mortality.
- Initial analyses indicated a reduced risk of all-cause mortality (RR = 0.399) and cardiovascular mortality (RR = 0.295) with calcitriol.
- After adjusting for confounding variables, the significant association between oral active vitamin D and reduced mortality was no longer evident.
Conclusions:
- Oral active vitamin D treatment demonstrated an association with improved survival in maintenance hemodialysis patients.
- The observed survival benefit was less pronounced than previously reported.
- Larger cohort studies are recommended to definitively establish the survival benefits of oral active vitamin D in MHD patients.
Aims:
To analyze the relationship between oral active vitamin D treatment and mortality in maintenance hemodialysis (MHD) patients.
Methods:
We examined the association of oral calcitriol treatment with mortality in 156 MHD patients (80 men and 76 women; mean age: 59 ± 15 years). The survival analysis of all-cause and cardiovascular mortality was performed using the Kaplan-Meier survival and Cox proportional-hazards analyses.
Results:
In all, 108 of the 156 patients received active vitamin D treatment. The intact parathyroid hormone level was obviously lower in the patients who received active vitamin D treatment than in those who did not. Throughout the whole follow-up, overall mortality was 16.7% (26 deaths, 13 in each group). The cardiovascular mortality rates were 14.6% (8/48) in the control group and 4.6% (5/108) in the calcitriol group. The crude analysis of all-cause and cardiovascular mortality using the Kaplan-Meier curve showed a significant reduction in mortality risk for patients who received oral active vitamin D compared with those who did not receive it (p = 0.015 and 0.026, respectively). Cox's regression analysis showed that active vitamin D treatment was associated with a significantly lower risk of all-cause mortality (RR = 0.399, 95% CI 0.185-0.862, p = 0.019) and cardiovascular mortality (RR = 0.295, 95% CI 0.094-0.93, p = 0.037). However, after adjusting for potential confounding variables, oral active vitamin D therapy was no longer clearly associated with a lower risk of either all-cause or cardiovascular mortality.
Conclusion:
Oral active vitamin D treatment was associated with improved survival in MHD patients. However, this survival benefit was smaller than previously reported, and a large cohort study should be performed.
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