Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 70101, Taiwan.
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
BMC Nephrol. 2018 Nov 6;19(1):309. doi: 10.1186/s12882-018-1111-2.
Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality.
In this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships.
During the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95% CI, 0.87-0.95]) and after propensity score matching (HR 0.94 [95% CI, 0.90-0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95% CI, 0.63-0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting.
Our findings supported the survival benefits of activated vitamin D among incident hemodialysis patients.
终末期肾病患者的全因死亡率和心血管死亡率均较高。继发性甲状旁腺功能亢进和维生素 D 缺乏被认为是观察到的死亡率过高的部分机制。我们旨在评估维生素 D 应用与全因死亡率之间的关系。
在这项回顾性队列研究中，我们纳入了所有 2001 年至 2009 年在台湾开始血液透析的首发患者。患者从标记时间（即开始血液透析后的第 360 天）开始随访，直至 2010 年底或死亡。我们使用条件标记分析和 Cox 回归评估标记时间前是否使用活性维生素 D 与全因死亡率之间的关联。我们使用基于群组的轨迹模型将高剂量与平均剂量使用者进行分类，以评估剂量反应关系。
在从标记时间开始的中位随访 1019 天期间，维生素 D 使用者的粗死亡率低于未使用者（每 100 人年 8.98 与 12.93）。与未使用者相比，多变量 Cox 模型（HR 0.91[95%CI，0.87-0.95]）和倾向评分匹配后（HR 0.94[95%CI，0.90-0.98]），维生素 D 使用者的死亡风险较低。高剂量维生素 D 使用者的死亡风险低于常规剂量使用者，HR 0.75[95%CI，0.63-0.89]。当我们将标记时间重新定义为第 180 天或在医院环境下进行血液透析的患者中重复分析时，维生素 D 治疗与降低死亡率之间的关联并未改变。
我们的研究结果支持在首发血液透析患者中使用活性维生素 D 可带来生存获益。
