Naves-Díaz Manuel, Alvarez-Hernández Daniel, Passlick-Deetjen Jutta, Guinsburg Adrian, Marelli Cristina, Rodriguez-Puyol Diego, Cannata-Andía Jorge B
Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Universidad de Oviedo, Julián Claveria s/n, 33006 Oviedo, Spain.
Kidney Int. 2008 Oct;74(8):1070-8. doi: 10.1038/ki.2008.343. Epub 2008 Jul 16.
Injection of active vitamin D is associated with better survival of patients receiving chronic hemodialysis. Since in many countries oral active vitamin D administration is the most common form of treatment for secondary hyperparathyroidism we determined the survival benefit of oral active vitamin D in hemodialysis patients from six Latin America countries (FME Register as part of the CORES study) followed for a median of 16 months. Time-dependent Cox regression models, after adjustment for potential confounders, showed that the 7,203 patients who received oral active vitamin D had significant reductions in overall, cardiovascular, infectious and neoplastic mortality compared to the 8,801 patients that had not received vitamin D. Stratified analyses found a survival advantage in the group that had received oral active vitamin D in 36 of the 37 strata studied including that with the highest levels of serum calcium, phosphorus and parathyroid hormone. The survival benefit of oral active vitamin D was seen in those patients receiving mean daily doses of less than 1 microg with the highest reduction associated with the lowest dose. Our study shows that hemodialysis patients receiving oral active vitamin D had a survival advantage inversely related to the vitamin dose.
注射活性维生素D与接受慢性血液透析的患者更好的生存率相关。由于在许多国家，口服活性维生素D是治疗继发性甲状旁腺功能亢进最常见的治疗方式，我们确定了来自六个拉丁美洲国家（作为CORES研究一部分的FME登记处）接受口服活性维生素D治疗的血液透析患者的生存获益情况，这些患者的随访时间中位数为16个月。在对潜在混杂因素进行调整后，时间依赖性Cox回归模型显示，与8801名未接受维生素D治疗的患者相比，7203名接受口服活性维生素D治疗的患者在总体、心血管、感染和肿瘤死亡率方面均有显著降低。分层分析发现，在研究的37个分层中的36个分层中，接受口服活性维生素D治疗的组具有生存优势，包括血清钙、磷和甲状旁腺激素水平最高的分层。口服活性维生素D的生存获益在那些平均每日剂量小于1微克的患者中可见，最大降幅与最低剂量相关。我们的研究表明，接受口服活性维生素D治疗的血液透析患者具有与维生素剂量呈负相关的生存优势。
