Association of oral calcitriol with improved survival in nondialyzed CKD

Abigail B. Shoben, Kyle D. Rudser, Ian H. De Boer, Bessie Young, Bryan Kestenbaum

Research output: Contribution to journalArticlepeer-review

223 Scopus citations

Abstract

Parenteral vitamin D is associated with improved survival among long-term hemodialysis patients. Among nondialyzed patients with chronic kidney disease (CKD), oral activated vitamin D reduces parathyroid hormone levels, but the impact on clinical outcomes is unknown. We evaluated associations of oral calcitriol use with mortality and dialysis dependence in 1418 nondialysis patients with CKD and hyperparathyroidism in the Veterans' Affairs Consumer Health Information and Performance Sets database. Incident calcitriol users and nonusers were selected on the basis of stages 3 to 4 CKD, hyperparathyroidism, and the absence of hypercalcemia before calcitriol use and then were matched by age and estimated kidney function. During a median follow-up of 1.9 yr, 408 (29%) patients died and 217 (16%) initiated long-term dialysis. After adjustment for demographics; comorbidities; estimated kidney function; medications; and baseline levels of parathyroid hormone, calcium, and phosphorous, oral calcitriol use was associated with a 26% lower risk for death (95% confidence interval 5 to 42% lower; P = 0.016) and a 20% lower risk for death or dialysis (95% confidence interval 1 to 35% lower; P = 0.038). The association of calcitriol with improved survival was not statistically different across baseline parathyroid hormone levels. Calcitriol use was associated with a greater risk for hypercalcemia. In conclusion, oral calcitriol use is associated with lower mortality in nondialysis patients with CKD.

Original languageEnglish (US)
Pages (from-to)1613-1619
Number of pages7
JournalJournal of the American Society of Nephrology
Volume19
Issue number8
DOIs
StatePublished - Aug 2008

Fingerprint Dive into the research topics of 'Association of oral calcitriol with improved survival in nondialyzed CKD'. Together they form a unique fingerprint.

Cite this