Impact of Hypovitaminosis D and Alfacalcidol Therapy on Survival of Hemodialysis Patients: Results from the French ARNOS Study

Abstract

Background: In chronic kidney disease and dialysis patients, vitamin D deficiency is associated with mortality. In some observational studies, calcitriol analogue therapy was associated with a better survival rate in hemodialysis (HD) patients. The aim of this study was to determine the relationship between serum 25-hydroxyvitamin D (25-OHD) levels and alfacalcidol therapy with HD patients’ outcomes. Methods: We measured baseline 25-OHD levels using a cross-sectional analysis in 648 HD prevalent patients from the regional ARNOS French cohort. A 42-month survival analysis was applied according to serum 25-OHD level and calcitriol analogue therapy. Results: The prevalence of 25-OHD insufficiency <30 ng/ml was high (73%), with only 22% taking native vitamin D supplementation. A baseline 25-OHD level above the median value (18 ng/ml) was associated with lower all-cause mortality [hazard ratio (HR), 0.73 (0.5–0.96); p = 0.02] after adjustment for age, gender, dialysis vintage, calcemia, phosphatemia, cardiovascular disease, and diabetes. Only in monovariate analysis was low-dose oral alfacalcidol therapy associated with a better survival rate in patients with and without 25-OHD deficiency [HR, 0.7 (0.5–0.92); p = 0.05]. Conclusions: Our study shows that, among prevalent HD patients, low 25-OHD levels affect mortality. Alfacalcidol therapy, especially in small doses, may provide compensation, but this needs to be further confirmed using prospective controlled studies comparing native and active vitamin D compounds.

Vitamin D Treatment and Mortality in Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…Consequently, 14 records were included in the meta-analysis (table 1). They included an abstract [36] and an e-published article [26], both identified through the Renal Week Symposium 2010 abstract book. An additional publication [28] providing complementary information about the original study [27] contributed to the analysis but was considered as the same work.…”

“…There were 3 studies conducted in predialysis CKD patients [29,33,35]. Four studies were performed in patients incident to hemo-dialysis [31,37,38,40] and the remaining 7 studies in patients already on hemodialysis [26,27,30,32,34, 36,39]. Administered molecules were calcitriol (natural 1,25(OH) 2 D 3 ), paricalcitol (synthetic 1,25(OH) 2 D 3 analogue), alfacalcidol (synthetic prohormone, 1α(OH)D 3 ) or doxercalciferol (synthetic prohormone, 1α(OH)D 2 ).…”

“…Four studies reported information on parathyroidectomy. At baseline, its prevalence was <9% and was not influenced by treatment group [26,34,38]. During follow-up, the incidence of parathyroidectomy was <0.15% [37].…”

“…The association of vitamin D therapy with all-cause mortality was assessed in 13 studies [26,27,28,29,31,32,33,34,35,36,37,38,39,40] (fig. 2).…”

“…However, a greater effect was observed in vitamin D-deficient patients [26,36]. The high prevalence of vitamin D insufficiency and deficiency in CKD patients at early and final stages [7] suggests that many patients could benefit from nutritionally or medically restoring vitamin D activity.…”