title: Lower risk for cardiovascular mortality in oral 1alpha-hydroxy vitamin D3 users in a haemodialysis population.
abstract: BACKGROUND
  Renal failure results in deficiency of active vitamin D3 that has diverse effects on metabolism and organ functions. Treatment with active forms of vitamin D(3) ameliorates abnormalities in bone and mineral metabolism, cardiac function, immune response and others. We hypothesized that treatment with vitamin D(3) may be beneficial for survival in patients with end-stage renal disease (ESRD).
  
  
  METHODS
  We compared the risk of death between regular users (n = 162) and non-users (n = 80) of oral 1alpha-hydroxyvitamin D3 (alfacalcidol) in a cohort of ESRD patients undergoing haemodialysis for a follow-up of 61 +/- 23 months. The daily dose of alfacalcidol ranged from 0.25 to 1.5 microg, with a median of 0.5 microg.
  
  
  RESULTS
  The alfacalcidol users showed a lower risk of death from cardiovascular disease than the non-users in a univariate Cox model [hazards ratio (HR) 0.287, 95% confidence interval (CI) 0.127-0.649, P = 0.003], whereas the risk for death from non-cardiovascular disease was not different between the two groups. Stepwise multivariate Cox analysis showed that cardiovascular mortality was significantly associated with age, presence of diabetes mellitus and treatment with alfacalcidol (HR 0.377, 95% CI 0.246-0.578, P = 0.022).
  
  
  CONCLUSIONS
  These results indicate that use of oral alfacalcidol was associated with reduced risk for cardiovascular death in this cohort of ESRD patients. The result of this observational study warrants further randomized controlled trials with 1alpha-hydroxy vitamin D3 to confirm the possibility that such medication improves survival of ESRD patients.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. t-shoji@med.osaka-cu.ac.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.forename: Kayo
authors.initials: K
authors.lastname: Shinohara
authors.forename: Eiji
authors.initials: E
authors.lastname: Kimoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Emoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Tahara
authors.forename: Hidenori
authors.initials: H
authors.lastname: Koyama
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukumoto
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Takami
authors.initials: T
authors.lastname: Miki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tabata
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012306:Risk; D016019:Survival Analysis; D014808:Vitamin D Deficiency / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000276:Adjuvants, Immunologic; D006887:Hydroxycholecalciferols; C008088:alfacalcidol