Abstract
BackgroundPatients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality.MethodsIn this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships.ResultsDuring the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95% CI, 0.87–0.95]) and after propensity score matching (HR 0.94 [95% CI, 0.90–0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95% CI, 0.63–0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting.ConclusionsOur findings supported the survival benefits of activated vitamin D among incident hemodialysis patients.
Highlights
Patients with end stage renal disease have a high all-cause and cardiovascular mortality
Using National Health Insurance Research Database (NHIRD), we aimed to determine the prevalence of activated vitamin D prescriptions, including calcitriol and alfacalcidol, in incident hemodialysis patients in Taiwan and the association of vitamin D use with potential effect on all-cause mortality
According to the Dialysis Outcomes and Practice Pattern Study (DOPPS), intravenous vitamin D was most common in the United States but oral administration was more prevalent in all other countries
Summary
Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Cardiovascular disease is an important cause of death in patients with chronic kidney disease (CKD) [1, 2]. Apart from diabetes, dyslipidemia, and atherosclerosis, non-traditional risk factors, especially secondary hyperparathyroidism, vascular calcification, and heart failure, all play important roles in patients with CKD and end stage renal disease (ESRD) [3,4,5,6]. Low 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D levels are associated with increased all-cause and cardiovascular mortality in the general population, CKD, and uremic patients [8,9,10,11,12,13,14]. Treatment with activated vitamin D is associated with lower incidence of left ventricular hypertrophy, myocardial fibrosis, and pulmonary congestion [17, 19, 20].
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