Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q-Cohort Study

Nephrol Dial Transplant. 2016 Jul;31(7):1152-60. doi: 10.1093/ndt/gfw205. Epub 2016 May 27.


Background: Hemodialysis patients who receive vitamin D receptor activator (VDRA) reportedly have better survival after infection than those who do not. However, the optimal route of its administration for minimizing death from infection remains unclear.

Methods: This prospective cohort study aimed to compare the effectiveness of oral versus intravenous VDRA regarding infection-related mortality in 3372 hemodialysis patients. Eligible subjects were divided into the following three groups by route of administration of VDRA: oral (n = 1868), intravenous (n = 492) and not administered (n = 1012). The effect of VDRA on infection-related mortality was examined using a Cox regression model with propensity score-based adjustments.

Results: During follow-up (median, 4.0 years), 118 study patients died of infection. There was a significantly lower incidence of death from infection in subjects who received intravenous VDRA than in those who did not receive VDRA; however, oral VDRA did not significantly reduce the risk of mortality from infection compared with those who did not receive VDRA [hazard ratio (HR) for intravenous VDRA, 0.16; 95% confidence interval (CI), 0.10-0.25, and HR for oral VDRA, 0.78; 95% CI, 0.60-1.01]. Direct comparison between the oral and intravenous VDRA groups showed that the intravenous group had significantly better survival than the oral group (HR, 0.39; 95% CI, 0.27-0.62).

Conclusions: Treatment with intravenous VDRA more effectively reduces the incidence of mortality from infection than oral VDRA in hemodialysis patients.

Keywords: infection; mortality; propensity score; prospective cohort; vitamin D.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Intravenous
  • Administration, Oral
  • Aged
  • Female
  • Humans
  • Incidence
  • Infections / drug therapy
  • Infections / mortality*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Receptors, Calcitriol / agonists
  • Renal Dialysis
  • Renal Insufficiency, Chronic / microbiology
  • Renal Insufficiency, Chronic / mortality*
  • Renal Insufficiency, Chronic / therapy
  • Vitamin D / administration & dosage*


  • Receptors, Calcitriol
  • Vitamin D