Mortality Risk Among Hemodialysis Patients Receiving Different Vitamin D Analogs

Kidney Int. 2006 Nov;70(10):1858-65. doi: 10.1038/sj.ki.5001868. Epub 2006 Oct 4.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / therapeutic use*
  • Bone Diseases, Metabolic / blood
  • Calcitriol / therapeutic use*
  • Calcium / blood
  • Ergocalciferols / therapeutic use*
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / drug therapy*
  • Hyperparathyroidism, Secondary / mortality
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Phosphorus / blood
  • Renal Dialysis / adverse effects
  • Renal Dialysis / mortality*
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Vitamin D / analogs & derivatives*

Substances

  • Bone Density Conservation Agents
  • Ergocalciferols
  • Parathyroid Hormone
  • Vitamin D
  • Phosphorus
  • 1 alpha-hydroxyergocalciferol
  • paricalcitol
  • Calcitriol
  • Calcium