Tentori F, Hunt W C, Stidley C A, Rohrscheib M R, Bedrick E J, Meyer K B, Johnson H K, Zager P G
Dialysis Clinic Inc., Albuquerque, New Mexico, USA.
Kidney Int. 2006 Nov;70(10):1858-65. doi: 10.1038/sj.ki.5001868. Epub 2006 Oct 4.
Intravenous vitamin D is standard therapy for secondary hyperparathyroidism in hemodialysis (HD) patients. In for-profit dialysis clinics, mortality was higher for patients on calcitriol compared to paricalcitol. Doxercalciferol, a second vitamin D2 analog, is currently available. We assessed mortality associated with each vitamin D analog and with lack of vitamin D therapy in patients who began HD at Dialysis Clinic Inc. (DCI), a not-for-profit dialysis provider. During the 1999-2004 study period we studied 7731 patients (calcitriol: n=3212; paricalcitol: n=2087; doxercalciferol: n=2432). Median follow-up was 37 weeks. Mortality rates (deaths/100 patient-years) were identical in patients on doxercalciferol (15.4, 95% confidence interval (13.6-17.1)) and paricalcitol (15.3 (13.6-16.9)) and higher in patients on calcitriol (19.6 (18.2-21.1)) (P<0.0001). In all models mortality was similar for paricalcitol versus doxercalciferol (hazard ratios=1.0). In unadjusted models, mortality was lower in patients on doxercalciferol (0.80 (0.66, 0.96)) and paricalcitol (0.79 (0.68, 0.92)) versus calcitriol (P<0.05). In adjusted models, this difference was not statistically significant. In all models mortality was higher for patients who did not receive vitamin D versus those who did (1.2 (1.1-1.3)). Mortality in doxercalciferol- and paricalcitol-treated patients was virtually identical. Differences in survival between vitamin D2 and D3 may be smaller than previously reported.
静脉注射维生素D是血液透析（HD）患者继发性甲状旁腺功能亢进的标准治疗方法。在营利性透析诊所，接受骨化三醇治疗的患者死亡率高于接受帕立骨化醇治疗的患者。多西骨化醇是另一种维生素D2类似物，目前已可使用。我们评估了非营利性透析服务提供商透析诊所公司（DCI）开始接受血液透析的患者中，每种维生素D类似物以及未接受维生素D治疗与死亡率之间的关系。在1999 - 2004年研究期间，我们研究了7731名患者（骨化三醇组：n = 3212；帕立骨化醇组：n = 2087；多西骨化醇组：n = 2432）。中位随访时间为37周。多西骨化醇治疗的患者死亡率（死亡数/100患者年）为15.4（95%置信区间（13.6 - 17.1）），与帕立骨化醇治疗患者的死亡率15.3（13.6 - 16.9）相同，而骨化三醇治疗患者的死亡率更高，为19.6（18.2 - 21.1）（P < 0.0001）。在所有模型中，帕立骨化醇与多西骨化醇的死亡率相似（风险比 = 1.0）。在未调整模型中，多西骨化醇治疗的患者（0.80（0.66，0.96））和帕立骨化醇治疗的患者（0.79（0.68，0.92））的死亡率低于骨化三醇治疗的患者（P < 0.05）。在调整模型中，这种差异无统计学意义。在所有模型中，未接受维生素D治疗的患者死亡率高于接受维生素D治疗的患者（1.2（1.1 - 1.3））。多西骨化醇和帕立骨化醇治疗患者的死亡率几乎相同。维生素D2和D3之间的生存差异可能比之前报道的要小。
