Mortality risk among hemodialysis patients receiving different vitamin D analogs

Tentori, Francesca; Hunt, William C.; Stidley, Christine A.; Rohrscheib, Mark; Bedrick, Edward J.; Meyer, Klemens B.; Johnson, Howard; Zager, Philip G.

doi:10.1038/sj.ki.5001868

Cited by 363 publications

(273 citation statements)

References 45 publications

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“…[25][26][27][28][29] Thus, although black and Hispanic patients with kidney disease are at greater risk for developing more severe secondary hyperparathyroidism, 34 this disadvantage seems to translate into a potential advantage once dialysis is initiated. This hypothesis is supported by the observation that among patients who were not treated with activated vitamin D, black patients had signifi- CLINICAL EPIDEMIOLOGY www.jasn.org cantly worse outcomes than white patients, a finding that remained robust to a variety of sensitivity analyses.…”

Section: Discussionmentioning

confidence: 99%

“…16 -24 Intravenous activated vitamin D was introduced in the middle to late 1980s to manage secondary hyperparathyroidism on dialysis, but beyond this role, several observational studies suggested an independent survival benefit associated with its use in dialysis. [25][26][27][28][29] Healthy black and Hispanic individuals and those with kidney disease have lower levels of vitamin D and consequently higher levels of parathyroid hormone (PTH) compared with non-Hispanic white individuals. 30 -34 These differences are exaggerated further once patients reach dialysis, 35 suggesting that black and Hispanic individuals would be more likely to be treated with intravenous activated vitamin D. We hypothesized that greater use of activated vitamin D among black and Hispanic patients is one factor that contributes to their survival advantage compared with non-Hispanic white patients.…”

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confidence: 99%

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Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients

Wolf¹,

Betancourt

Chang

et al. 2008

Journal of the American Society of Nephrology

153

111

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Contrary to most examples of disparities in health outcomes, black patients have improved survival compared with white patients after initiating hemodialysis. Understanding potential explanations for this observation may have important clinical implications for minorities in general. This study tested the hypothesis that greater use of activated vitamin D therapy accounts for the survival advantage observed in black and Hispanic patients on hemodialysis. In a prospective cohort of non-Hispanic white (n ϭ 5110), Hispanic white (n ϭ 979), and black (n ϭ 3214) incident hemodialysis patients, higher parathyroid hormone levels at baseline were the primary determinant of prescribing activated vitamin D therapy. Median parathyroid hormone was highest among black patients, who were most likely to receive activated vitamin D and at the highest dosage. One-year mortality was lower in black and Hispanic patients compared with white patients (16 and 16 versus 23%; P Ͻ 0.01), but there was significant interaction between race and ethnicity, activated vitamin D therapy, and survival. In multivariable analyses of patients treated with activated vitamin D, black patients had 16% lower mortality compared with white patients, but the difference was lost when adjusted for vitamin D dosage. In contrast, untreated black patients had 35% higher mortality compared with untreated white patients, an association that persisted in several sensitivity analyses. In conclusion, therapy with activated vitamin D may be one potential explanation for the racial differences in survival among hemodialysis patients. Further studies should determine whether treatment differences based on biologic differences contribute to disparities in other conditions.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients

Wolf¹,

Betancourt

Chang

et al. 2008

Journal of the American Society of Nephrology

153

111

View full text Add to dashboard Cite

show abstract

“…Moreover, the results of one of these observational studies in hemodialysis patients suggested a survival advantage with paricalcitol as compared with calcitriol (74), but another failed to identify such a difference (76). These effects appeared to be independent of changes in serum calcium and phosphorus.…”

Section: Case In Favor Of Vitamin D or Active Vitamin D Derivatives Amentioning

confidence: 99%

“…These effects appeared to be independent of changes in serum calcium and phosphorus. A major problem with historical cohort analyses of drug effects, however, is the risk of residual and unmeasured confounding by indication (48,76,78). Unfortunately, definite controlled, prospective evidence for the benefit of administration of native vitamin D or vitamin D derivatives in CKD patients on outcome, that is, morbidity or mortality, is not yet available, as pointed out in a recent meta-analysis (48).…”

Section: Case In Favor Of Vitamin D or Active Vitamin D Derivatives Amentioning

confidence: 99%

Treatment of Secondary Hyperparathyroidism in CKD Patients with Cinacalcet and/or Vitamin D Derivatives

Drüeke¹,

Ritz²

2009

Clinical Journal of the American Society of Nephrology

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The discovery of the calcium-sensing receptor (CaR) 15 yr ago was rapidly followed by the development of drugs modulating its activity, the so-called calcimimetics (increasing the CaR signal) and calcilytics (decreasing the CaR signal). The indication for calcimimetics is treatment of primary and secondary hyperparathyroidism, whereas calcilytics have potential for treatment of osteoporosis. A large number of clinical studies has shown that cinacalcet, the only presently available calcimimetic, effectively reduces serum parathyroid hormone in dialysis patients with secondary hyperparathyroidism. In contrast to the effect of active vitamin D derivatives, it simultaneously decreases serum calcium and phosphorus. Experimental studies showed a concomitant decrease in parathyroid hyperplasia. In the treatment of secondary hyperparathyroidism of dialysis patients, important questions remain unresolved, for example, whether there are reasons to prefer calcimimetics to active vitamin D derivatives and whether combined administration offers advantages compared with calcimimetics or active vitamin D given in isolation. For lowering parathyroid hormone, available evidence from recent studies suggests that combination therapy should be preferred to single drug treatment because of less side-effects and greater efficacy in controlling parathyroid overfunction. Future randomized controlled trial must answer whether calcimimetics impact on cardiovascular events or survival and whether in this respect there are differences between vitamin D sterols and calcimimetics.

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“…Several recent observational studies have shown that the administration of any dosage of any active vitamin D is associated with significantly better survival independent of the level of calcium, phosphorus, or PTH; these studies, in turn, might have de-emphasized the dangers of calcium loading (3,46,47). As part of the same trend, more recent epidemiologic analyses have reopened the question regarding the optimal range of serum calcium (3).…”

Section: Confounded Battle Groundmentioning

confidence: 99%

Battleground

Kövesdy¹,

Mehrotra²,

Kalantar-Zadeh³

2008

Clinical Journal of the American Society of Nephrology

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Renal osteodystrophy is a significant complication in chronic kidney disease. This condition is referred to as mineral and bone disorders in chronic kidney disease, mainly because of its wider ranging impact, including an association with increased mortality and non-bone-related morbidity. Because most of the abnormalities that characterize mineral and bone disorders in chronic kidney disease (e.g., hyperphosphatemia, secondary hyperparathyroidism) are amenable to therapeutic interventions, this field has also been in the cross-hairs of many pharmaceutical companies. The advent of a number of new therapeutic options for mineral and bone disorders in chronic kidney disease has broadened our armamentarium but has also resulted in an intense marketing battle between pharmaceutical companies. The paucity of randomized, controlled trials in this field has allowed the various companies to promote unilaterally data that fit their needs and to attempt to discredit data that support their competitors' products. Although this attitude is expected and regarded as acceptable in a consumer society, on a scientific level, it has resulted in a polarized and often confused audience: The practicing nephrologists. This article provides a historical overview of how the field of mineral and bone disorders in chronic kidney disease has evolved from a pharmaceutical standpoint, with a critical emphasis of the key moments that resulted in the current acrimonious climate. Also assessed is what the key unanswered questions are in this field, and practical solutions to the discussed issues are provided.

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Mortality risk among hemodialysis patients receiving different vitamin D analogs

Cited by 363 publications

References 45 publications

Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients

Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients

Treatment of Secondary Hyperparathyroidism in CKD Patients with Cinacalcet and/or Vitamin D Derivatives

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