Performance Status Modifies the Association Between Vitamin D Receptor Activator and Mortality or Fracture: A Prospective Cohort Study on the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry

Abstract

Immobilization osteoporosis is characterized by excess bone resorption. Vitamin D receptor activators (VDRA) might have adverse effects in immobilized patients. The objective of this study was to elucidate the impact of performance status (PS) on the associations between VDRA use and outcomes among hemodialysis patients. This is a prospective cohort study. Adults on hemodialysis in the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry were included. Exposure of interest was the use of VDRA. Outcomes were all‐cause mortality and hip fracture. Associations between VDRA use and mortality or hip fractures were examined by Cox and Poisson regression analyses, respectively. Among 208,512 subjects, 128,535 were on VDRA. Poor PS was associated with higher calcium (Ca), lower parathyroid hormone, and higher alkaline phosphatase levels. The association between higher Ca levels and VDRA use was stronger among those with poor PS (p interaction 0.007). Adjusted hazard ratio (HR) (95% confidence interval [CI]) for mortality and incidence rate ratio (IRR) for hip fracture was 1.02 (95% CI, 0.99–1.05) and 0.93 (0.86–1.00) among users of VDRA, respectively. The VDRA use was associated with lower mortality and incidence of hip fractures among subjects with good PS but not among subjects with poor PS (p interaction 0.03 and 0.05). Effect modification by PS was observed for cardiovascular (CV) mortality but not for non‐CV mortality. In conclusion, VDRA use was associated with better outcomes only among those with good PS. These results suggest that bone and mineral disorders among hemodialysis patients should be treated differently, depending on their performance status. © 2022 American Society for Bone and Mineral Research (ASBMR).

Associations of vitamin D receptor activators and calcimimetics with falls and effect modifications by physical activity: A prospective cohort study on the Japan Dialysis Outcomes and Practice Patterns Study

“…We have recently shown that the use of VDRA was associated with a lower incidence of fracture (not falls) among those with better physical activity [34]. Some patients might develop fractures from a minor fall while not all falls result in fractures.…”

Cystacin C-based eGFR and Creatinine Clearance-based eGFR in Patients with Severe Motor and Intellectual Disabilities

“…Moreover, the number of Japanese patients with CKD is estimated to be approximately 13.3 million, of which approximately 1 in 8 adults has CKD, and the prevalence of CKD is high among the elderly (2) . Subsequently, the aging of patients with chronic dialysis has been noticeable in recent years, and the statistical analysis survey results by the Japanese Society for Dialysis Medicine [the annual report of The Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry (JRDR)] also revealed that the number of patients with chronic dialysis would reach approximately 350,000 by the end of 2021, with an increasing trend in patients aged ≥70 years (9) , (10) , (11) . Particularly, patients undergoing chronic dialysis are reported to have high mortality and hospitalization rates.…”