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

Tanaka, Shigeru; Ninomiya, Toshiharu; Taniguchi, Masatomo; Fujisaki, Kiichiro; Tokumoto, Masanori; Hirakata, Hideki; Ooboshi, Hiroaki; Kitazono, Takanari; Tsuruya, Kazuhiko

doi:10.1093/ndt/gfw205

Cited by 27 publications

(23 citation statements)

References 39 publications

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“…At the moment, no interventional study showed any survival advantage for CKD and dialysis patients using native vitamin D supplementation. Tanaka et al reported that infection-related mortality in Japan is reduced in patients receiving VDRA mostly intravenously [106]. In a recent meta-analysis of CKD, Li et al reported that VDRAs reduced the incidence of cardiovascular events and reduced proteinuria, but resulted in an increased probability of hypercalcemia when paricalcitol was used [107].…”

Section: Vdra For Ckd and Dialysis Patientsmentioning

confidence: 99%

Vitamin D in Chronic Kidney Disease and Dialysis Patients

2017

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Vitamin D deficiency (<20 ng/mL) and insufficiency (20–29 ng/mL) are common among patients with chronic kidney disease (CKD) or undergoing dialysis. In addition to nutritional and sunlight exposure deficits, factors that affect vitamin D deficiency include race, sex, age, obesity and impaired vitamin D synthesis and metabolism. Serum 1,25(OH)2D levels also decrease progressively because of 25(OH)D deficiency, together with impaired availability of 25(OH)D by renal proximal tubular cells, high fibroblast growth factor (FGF)-23 and decreased functional renal tissue. As in the general population, this condition is associated with increased morbidity and poor outcomes. Together with the progressive decline of serum calcitriol, vitamin D deficiency leads to secondary hyperparathyroidism (SHPT) and its complications, tertiary hyperparathyroidism and hypercalcemia, which require surgical parathyroidectomy or calcimimetics. Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease Improving Global Outcomes (KDIGO) experts have recognized that vitamin D insufficiency and deficiency should be avoided in CKD and dialysis patients by using supplementation to prevent SHPT. Many vitamin D supplementation regimens using either ergocalciferol or cholecalciferol daily, weekly or monthly have been reported. The benefit of native vitamin D supplementation remains debatable because observational studies suggest that vitamin D receptor activator (VDRA) use is associated with better outcomes and it is more efficient for decreasing the serum parathormone (PTH) levels. Vitamin D has pleiotropic effects on the immune, cardiovascular and neurological systems and on antineoplastic activity. Extra-renal organs possess the enzymatic capacity to convert 25(OH)D to 1,25(OH)2D. Despite many unanswered questions, much data support vitamin D use in renal patients. This article emphasizes the role of native vitamin D replacement during all-phases of CKD together with VDRA when SHPT persists.

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Section: Vdra For Ckd and Dialysis Patientsmentioning

confidence: 99%

Vitamin D in Chronic Kidney Disease and Dialysis Patients

2017

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“…Accordingly, our data should be interpreted cautiously based on the historical context described above. In addition, because VDRAs were shown to exert protective effects against infection-related death in hemodialysis patients 15 , our data suggest that the dose of VDRAs for treatment of secondary hyperparathyroidism should be adjusted cautiously to avoid induction of VDRA-related hypercalcemia.…”

Section: Discussionmentioning

confidence: 91%

“…The present study aimed to determine whether serum calcium level is associated with risk of infection-related death in hemodialysis patients. To achieve this aim, we analyzed the dataset in the Q-Cohort Study, a multicenter, prospective, observational study of hemodialysis patients in Japan [14][15][16] .…”

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confidence: 99%

Increased Risk of Infection-Related and All-Cause Death in Hypercalcemic Patients Receiving Hemodialysis: The Q-Cohort Study

Yamada

Arase

Tokumoto

et al. 2020

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Although hypercalcemia is a risk factor for all-cause mortality in hemodialysis patients, it remains unknown whether hypercalcemia increases the risk of infection-related death. A total of 2869 hemodialysis patients registered in the Q-cohort Study, a multicenter, prospective cohort study of hemodialysis patients, were analyzed. the predictor was albumin-corrected serum calcium level at baseline. the main outcome was infection-related death. Death risk were estimated by multivariableadjusted cox proportional hazard risk models and competing risk models. During the follow-up period of 4 years, 107 patients died of infection and 473 died of any cause. The patients were divided into four groups by the serum calcium level at baseline (G1, 5.7-8.9 mg/dL; G2, 9.0-9.4 mg/dL; G3, 9.5-9.9 mg/L; G4 10.0-16.5 mg/dL). In the multivariable-adjusted model, the incidence of infection-related death was significantly higher in the highest serum calcium group (G4) compared with the lowest serum calcium group (G1): hazard ratio [95% confidence interval], 2.34 [1.35-4.04], P = 0.002. Furthermore, higher serum calcium level was significantly associated with increased risk of all-cause death. In conclusion, our data suggest that a higher serum calcium level may be a risk factor for infection-related and all-cause death in hemodialysis patients.

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“…The 5 hazards ratios (HRs) calculated in each stratum were combined into an overall treatment effect [10]. Matched pairs were constructed using the greedy matching algorithm with a caliper width of 0.2 SDs of the logit of the propensity score, at a ratio of 1: 1 without replacement [11, 12]. Statistical analysis was performed using commercially available software (JMP Statistics version 11.0; SAS Institute, Tokyo, Japan).…”

Section: Methodsmentioning

confidence: 99%

Study on Dialysis Session Length and Mortality in Maintenance Hemodialysis Patients: The Q-Cohort Study

Fujisaki

Tanaka

Taniguchi³

et al. 2018

Nephron

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Objectives: Hemodialysis (HD) time has been recognized as an important factor in dialysis adequacy. However, few studies have reported on associations between HD time and prognosis among maintenance HD patients. We present some findings from a prospective cohort study, the Q-Cohort Study, which was set up to explore risk factors for mortality in Japanese HD patients. We hypothesized that HD ≥5 h was associated with a signiﬁcant survival advantage compared with HD < 5 h. The present study examined association between HD time and mortality in Japanese HD patients. Methods: The prospective multicenter Q-Cohort Study was conducted between December 2006 and December 2010, following 3,456 Japanese HD patients for 4 years. We examined the association between HD time and prognosis using Cox proportional hazards modeling. Propensity scores were calculated using logistic regression. Results: During follow-up, 566 patients died from any cause. Patients with HD ≥5 h (n = 2,141) showed significantly lower risk of all-cause death (hazards ratio = 0.82; 95% CI 0.68–0.99) than those with HD < 5 h (n = 1,315), after adjusting for confounding risk factors. This association remained significant using a propensity score-based approach. After stratifying the analysis by patient age in 10-year increments, this finding remained significant only in patients who were ≥80 years of age. Conclusion: Our results suggest that HD ≥5 h has a more favorable effect on mortality than HD < 5 h.

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

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

Cited by 27 publications

References 39 publications

Vitamin D in Chronic Kidney Disease and Dialysis Patients

Vitamin D in Chronic Kidney Disease and Dialysis Patients

Increased Risk of Infection-Related and All-Cause Death in Hypercalcemic Patients Receiving Hemodialysis: The Q-Cohort Study

Study on Dialysis Session Length and Mortality in Maintenance Hemodialysis Patients: The Q-Cohort Study

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