Mortality risk among hemodialysis patients receiving different vitamin D analogs

F. Tentori, W. C. Hunt, C. A. Stidley, M. R. Rohrscheib, E. J. Bedrick, K. B. Meyer, H. K. Johnson, P. G. Zager

Research output: Contribution to journalArticlepeer-review

356 Scopus citations

Abstract

Intravenous vitamin D is standard therapy for secondary hyperparathyroidism in hemodialysis (HD) patients. In for-profit dialysis clinics, mortality was higher for patients on calcitriol compared to paricalcitol. Doxercalciferol, a second vitamin D2 analog, is currently available. We assessed mortality associated with each vitamin D analog and with lack of vitamin D therapy in patients who began HD at Dialysis Clinic Inc. (DCI), a not-for-profit dialysis provider. During the 1999-2004 study period we studied 7731 patients (calcitriol: n = 3212; paricalcitol: n = 2087; doxercalciferol: n = 2432). Median follow-up was 37 weeks. Mortality rates (deaths/100 patient-years) were identical in patients on doxercalciferol (15.4, 95% confidence interval (13.6-17.1)) and paricalcitol (15.3 (13.6-16.9)) and higher in patients on calcitriol (19.6 (18.2-21.1)) (P<0.0001). In all models mortality was similar for paricalcitol versus doxercalciferol (hazard ratios = 1.0). In unadjusted models, mortality was lower in patients on doxercalciferol (0.80 (0.66, 0.96)) and paricalcitol (0.79 (0.68, 0.92)) versus calcitriol (P<0.05). In adjusted models, this difference was not statistically significant. In all models mortality was higher for patients who did not receive vitamin D versus those who did (1.2 (1.1-1.3)). Mortality in doxercalciferol- and paricalcitol-treated patients was virtually identical. Differences in survival between vitamin D2 and D3 may be smaller than previously reported.

Original languageEnglish (US)
Pages (from-to)1858-1865
Number of pages8
JournalKidney International
Volume70
Issue number10
DOIs
StatePublished - Nov 27 2006
Externally publishedYes

Keywords

  • Calcitriol
  • Doxercalciferol
  • Hemodialysis
  • Mortality
  • Paricalcitol
  • Vitamin D

ASJC Scopus subject areas

  • Nephrology

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