Effects of monthly dose and regular dosing of intravenous active vitamin D use on mortality among patients undergoing hemodialysis. Export

@article{citeulike:5918189, abstract = {STUDY OBJECTIVES: To determine if apparent protective mortality benefits of intravenous active vitamin D in patients undergoing hemodialysis extend across all groups defined by dialysis duration; if higher monthly dose and dosing regularity are associated with reduced mortality; and if intravenous active vitamin D use is associated with reduced cardiovascular, infectious, and cancer-related mortality. STUDY DESIGN: Retrospective cohort study. DATA SOURCE: Centers for Medicare and Medicaid Services End-Stage Renal Disease database. PATIENTS: A total of 193,830 patients undergoing hemodialysis during 1999-2000, of whom 94,208 (48.6\%) were taking intravenous active vitamin D in the baseline period. MEASUREMENTS AND MAIN RESULTS: Time-varying Cox proportional hazards models were used to assess the effects of monthly vitamin D dose and dosing regularity over 3-month intervals on risk of all-cause and cause-specific death, by dialysis duration groups (<1 yr, 1 to <3 yrs, 3 to <5 yrs, and >or=5 yrs from dialysis initiation). Models were adjusted for baseline characteristics, time-varying hospital days, monthly epoetin alfa dose, mean hemoglobin level, and urea reduction ratio in the 3-month intervals. Maximum follow-up time was 5.25 years. Adjusted all-cause mortality risk was reduced 7-17\% among patients receiving vitamin D each month of the 3-month interval, with the highest reduction among patients with shorter dialysis duration. However, regular vitamin D dosing did not show consistent benefit across dialysis duration groups for cardiovascular, infectious, cancer, or other (all deaths not attributable to cardiovascular disease, infection, or cancer) mortality. CONCLUSION: Mortality benefits of intravenous vitamin D cannot be easily explained by currently proposed biologic mechanisms. Randomized controlled trials are needed to show definitively whether intravenous vitamin D can reduce all-cause and cause-specific mortality in patients undergoing dialysis compared with placebo.}, author = {St Peter, Wendy L. and Li, Shuling and Liu, Jiannong and Gilbertson, David T. and Arneson, Thomas J. and Collins, Allan J.}, citeulike-article-id = {5918189}, citeulike-linkout-0 = {http://dx.doi.org/10.1592/phco.29.2.154}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19170585}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19170585}, doi = {10.1592/phco.29.2.154}, issn = {0277-0008}, journal = {Pharmacotherapy}, keywords = {hd, mortality, vitamin-d}, month = {February}, number = {2}, pages = {154--164}, posted-at = {2009-10-10 03:26:54}, priority = {2}, title = {Effects of monthly dose and regular dosing of intravenous active vitamin D use on mortality among patients undergoing hemodialysis.}, url = {http://dx.doi.org/10.1592/phco.29.2.154}, volume = {29}, year = {2009} }

TY - JOUR ID - citeulike:5918189 L3 - citeulike-article-id:5918189 N2 - STUDY OBJECTIVES: To determine if apparent protective mortality benefits of intravenous active vitamin D in patients undergoing hemodialysis extend across all groups defined by dialysis duration; if higher monthly dose and dosing regularity are associated with reduced mortality; and if intravenous active vitamin D use is associated with reduced cardiovascular, infectious, and cancer-related mortality. STUDY DESIGN: Retrospective cohort study. DATA SOURCE: Centers for Medicare and Medicaid Services End-Stage Renal Disease database. PATIENTS: A total of 193,830 patients undergoing hemodialysis during 1999-2000, of whom 94,208 (48.6%) were taking intravenous active vitamin D in the baseline period. MEASUREMENTS AND MAIN RESULTS: Time-varying Cox proportional hazards models were used to assess the effects of monthly vitamin D dose and dosing regularity over 3-month intervals on risk of all-cause and cause-specific death, by dialysis duration groups (<1 yr, 1 to <3 yrs, 3 to <5 yrs, and >or=5 yrs from dialysis initiation). Models were adjusted for baseline characteristics, time-varying hospital days, monthly epoetin alfa dose, mean hemoglobin level, and urea reduction ratio in the 3-month intervals. Maximum follow-up time was 5.25 years. Adjusted all-cause mortality risk was reduced 7-17% among patients receiving vitamin D each month of the 3-month interval, with the highest reduction among patients with shorter dialysis duration. However, regular vitamin D dosing did not show consistent benefit across dialysis duration groups for cardiovascular, infectious, cancer, or other (all deaths not attributable to cardiovascular disease, infection, or cancer) mortality. CONCLUSION: Mortality benefits of intravenous vitamin D cannot be easily explained by currently proposed biologic mechanisms. Randomized controlled trials are needed to show definitively whether intravenous vitamin D can reduce all-cause and cause-specific mortality in patients undergoing dialysis compared with placebo. IS - 2 JF - Pharmacotherapy SN - 0277-0008 EP - 164 TI - Effects of monthly dose and regular dosing of intravenous active vitamin D use on mortality among patients undergoing hemodialysis. VL - 29 SP - 154 KW - hd KW - mortality KW - vitamin-d AU - St Peter, Wendy AU - Li, Shuling AU - Liu, Jiannong AU - Gilbertson, David AU - Arneson, Thomas AU - Collins, Allan PY - 2009/02// UR - http://dx.doi.org/10.1592/phco.29.2.154 ER -